Do you sometimes have tears flowing from your eyes for no reason, and do you feel wet around your eyes? You may have to wipe them with a tissue all the time. This is really annoying. The main reason for this can be that the delicate tube system that carries the tears produced in your eyes to your nose, called the tear duct, is blocked. Today, we will talk about a surgery that is the best solution for this.
What is DCR surgery?
Simply put, dacryocystorhinostomy, or DCR for short, is a procedure that creates a new path for your tears to flow if they are blocked.
Normally, the tears produced in our eyes enter through the tiny holes at the corners of the eyes, pass through the tear sac, and flow into the nose. You may remember that when we cry, or when something gets in our eyes and tears come out, a stream of liquid also flows out of our nose. This is the reason for this. So if this tear duct is blocked somewhere, the tears have nowhere to go and start overflowing from the eyes. This not only keeps the eyes moist all the time, but sometimes serious infections can also occur.
This condition can be seen among young children, as well as especially among adults over the age of 65.
How should I prepare before surgery?
Before you or your child has this surgery, you will need to see a specialist. This surgery is usually performed by an ophthalmologist or an ear, nose and throat surgeon (ENT surgeon). Sometimes, doctors from the same department perform the surgery together.
Your doctor will explain the surgery to you thoroughly and will also order several tests to see if you are a good candidate for the surgery.
In addition, an anesthesiologist will talk to you, as this surgery is performed under anesthesia.
Once the surgery date is set, your doctor will advise you on the following:
- Medications you take: If you are taking any medications, your doctor will tell you exactly whether you need to stop taking any of them before surgery, and if so, how.
- Keeping the skin clean: To reduce the risk of infection, you may be advised to wash your face with a special soap the night before surgery.
- Fasting: This is very important. The doctor will tell you exactly how many hours before the surgery you should stop eating and drinking. You should use it exactly at that time. Because if there is food in the stomach during anesthesia, if you vomit and those things go into the lungs, it can cause a serious condition that can even be life-threatening (`aspiration pneumonia`).
How is the surgery done?
As the surgery begins, an IV line, or saline tube, will be placed in a vein in your arm. This will give you anesthesia and fluids. You will then be put under anesthesia and completely asleep.
The doctor can perform this surgery in two main ways: by making an incision outside the nose (external) or inside the nose (endonasal).
| Surgical Method | What happens (Procedure) |
|---|---|
| External DCR | The doctor will make a very small incision in the skin between your nose and eye. Then, a small hole will be made in the bone that separates the tear duct from the nose. Through this hole, a thin tube (stent) will be inserted into the tear duct, with the other end directed into the nose. This tube will prevent the newly created passage from closing again. The incision will then be closed with stitches. |
| Endonasal DCR | In this method, there is no visible incision. The doctor inserts a camera-equipped device called an endoscope into the nose and makes an incision inside the nose. Through it, he goes to the place where the tear sac is and makes a hole in the bone. Then, a thin tube is inserted through the hole in the corner of the eye, brought inside the nose through the newly made hole, and fixed. In this case, something like foam can be used to control bleeding. |
How long does this surgery take?
Typically, for a first-time surgery, the external method can take about 45-50 minutes, and the intranasal method can take about 30 minutes. However, this time can vary.
What are the benefits of this surgery?
The biggest advantage of this is that you can completely get rid of the annoying condition of constantly tearing your eyes. Also:
- Vision becomes clear.
- The risk of infections around the eyes is reduced.
Most importantly, both of these procedures are highly successful surgeries, with success rates ranging from 85% to 99%.
Are there any risks and complications of the surgery?
As with any surgery, there are some minor risks. There are also some complications that are specific to this surgery.
| Risk type | Description |
|---|---|
| Common risks | Pain, bleeding, infection. |
| Specific risks | Scar tissue can form and cause a new blockage, the stent can come loose, or if it is removed from the outside, the wound can reopen or a scar can form. |
| A serious but very rare complication | Cerebrospinal Fluid (CSF) leak . This is when the fluid around the brain leaks out of the nose. This is very rare. If it does happen, another surgery will be needed to correct it. |
Your doctor will explain to you in detail what risks you may face.
What happens after the surgery?
This is usually an outpatient procedure. You will be monitored for a few hours after you wake up from the anesthesia and sent home. The doctor will prescribe painkillers and antibiotics. It is very important to take these medications exactly as prescribed.
You will be asked to come back for a check-up about a week after the surgery. The wound will then be examined and any dressings used to stop the bleeding will be removed. If an incision was made on the outside, the stitches will also be removed at this time.
How long does it take to heal?
It may take several weeks or even months to fully heal, as the hole made in the bone takes some time to heal.
There is one thing you should definitely not do during your recovery period. That is blowing your nose. Doing so can cause the wound to reopen and the tube to move around. You should avoid blowing your nose for at least a week. Your doctor will advise you on other things to avoid.
When should you see a doctor?
If you experience any of these symptoms after surgery, you should call your doctor immediately:
- If you get a fever.
- If the surgical site feels swollen and hot.
- If the wound continues to bleed or pus flows, or if the nosebleed does not stop.
- If the tears start flowing again.
Are there alternatives to DCR surgery?
Yes, there are several other options that your doctor may suggest instead of DCR surgery:
- Observation: If your discomfort is not severe, you may not need treatment.
- Medications: In some cases, you can try to control the condition with things like antibiotics and steroid eye drops.
- Tube insertion: Without surgery, a thin tube is inserted into the natural tear duct and left in place for about 3-6 months to see if it resolves the problem.
- Other surgeries: There are other specialized surgeries that are performed for those who have not had successful DCR surgery.
Constantly tearing eyes can be a real pain. But DCR is a very safe and effective solution to this problem. If you or someone in your family has this problem, see an ophthalmologist for advice. He or she will determine the most suitable treatment for you and provide the necessary guidance.
Take-Home Message
- DCR is a very successful surgery performed to treat conditions where tears are constantly flowing from the eyes due to blocked tear ducts.
- This surgery can be done in two main ways (external and intranasal). Your doctor will decide which method is best for you.
- It will take some time to fully heal. During that time, be sure to follow the doctor's instructions, especially the advice not to pick your nose too hard.
- If you experience any unusual symptoms after surgery, such as fever, swelling, or excessive bleeding, notify your doctor immediately.
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