DACRYOCYSTORHINOSTOMY (DCR):

What is DCR?

Each eye has a fine pipe which drains the tears from the eye. This is a nasolacrimal duct (drain-pipe of the eye). If it gets blocked, the tears and stickiness come out of the eye. The treatment is by dacryocystorhinostomy (DCR). This is a technique by which a new passage is created from the eye into the nose, and the tears can drain out.

Is it necessary to undergo DCR?

When a nasolacrimal duct is blocked, the dirt and discharge accumulate in the lacrimal sac next to the eye. There is the risk of severe eye infection if the condition is left untreated. There may be swelling, pain, and watering. If a cataract surgery is planned, a blocked nasolacrimal duct increases the risk of dangerous infection; a DCR should be done before the cataract surgery.

How is DCR performed? What are the outcomes?

DCR can be performed in three ways- externally, through a small (less than half inch) line next to the nose; endonasally- through the nose; and trans-canalicular using Laser DCR.

The external DCR leaves a fine mark near the eye; it has the highest success rates, more than 95 out of 100 patients have the problem completely solved after external DCR. An endo nasal DCR is done through the nose, so there is no mark outside. The success rates are a little lower; all nose space inside is not suitable for endonasal surgery, and it can be done well in selected patients only. Trans-canalicular Laser DCR is a very rapid procedure, with hardly any pain and swelling. However, some of the DCR done with laser may close down again.

I have had a DCR done already. The eye is still watering. Why?
As mentioned, about 5 out of 100 patients find that their DCR has closed down again. This may particularly happen in a patient who had multiple attacked of infection earlier, with a history of injury near the nose, or a patient who has frequent nasal allergies and colds. The DCR can be repeated, with addition of silicone intubation to prop the passage open. A typical oculoplastic surgeon will often see patients sent over from elsewhere after the DCR did not work; most such patients can be re-operated successfully.

Article by

Narayana Nethralaya