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.
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.