Summary
The external DCR is the traditional open approach to tear-duct surgery. Through a small, well-camouflaged skin incision beside the nose, the lacrimal sac is opened directly into the nose to create a new drainage pathway. It remains an excellent operation with very high success rates and a long track record.
Who is this for?
External DCR is particularly suited to:
- patients with previous failed endoscopic DCR,
- selected anatomical variations (very thick or distorted bone),
- suspicion of a lacrimal sac tumour requiring formal biopsy,
- patient preference after considering both options.
The aesthetic outcome of the small incision is excellent in the vast majority of patients.
On NHS funding: most integrated care boards, Hampshire included, have published no policy on tear duct surgery at all, which is not the same thing as a refusal. The watery eye assessment page has the detail and a lookup for your own area, and there is a fuller explanation in is eyelid surgery funded on the NHS?
What the procedure involves
Performed under general or local anaesthetic with sedation, taking around 60 to 75 minutes. A 10 to 15 mm incision is made just below the inner corner of the eye, the lacrimal sac is identified, a small disc of bone is removed, and the sac is opened directly into the nose. As with the endoscopic approach, a fine silicone stent is left in place for 6 to 12 weeks.
Recovery and what to expect
- A small dressing for 24 to 48 hours.
- Bruising and swelling for 1 to 2 weeks.
- Skin sutures are removed at 7 days.
- The silicone stent is removed in clinic at 6 to 12 weeks.
- Avoid heavy exercise and nose-blowing for 2 weeks.
Risks and alternatives
Risks include bleeding, scar tissue narrowing the new pathway, scar visibility, and very rarely injury to nearby structures. Long-term success rates are 90 to 95%.
Alternatives include endoscopic DCR for those who prefer to avoid a skin scar.