DISEASES AND TREATMENTS

Dacryocystorhinostomy

What is dacryocystorhinostomy?

Dacryocystorhinostomy, known as DCR, is a surgical procedure that involves creating a new tear drainage tube, from the eye to the nose, with the patient’s own tissue. It is indicated for patients with lacrimal duct obstruction and a watery eye, which are some of the most prevalent pathologies seen in the ophthalmology consultation.

What does the technique involve?

The surgery is called a dacryocystorhinostomy and involves the union through a tube between the eye and the nostril.

It can be done in two ways with guarantees. The most classic form is external dacryocystorhinostomy, where a small incision is made through which the new tube is created that is needed to drain that tear into the nostril. The success rate in expert hands is very high – higher than 95% in our hands, for example –, and the only drawback is that a skin incision has to be made. In young patients, it is not desirable to make any visible incisions.

The second way to do this is endoscopic dacryocystorhinostomy. It has many advantages over the external procedure, the most important of which being that there is no skin incision. With a camera and an endoscope through the nostril, we can make the same canal and solve the same problem with a success rate of more than 92%. Usually, when this route is taken, the recovery is much faster than with the external procedure, and patients have a lighter postoperative period, with fewer complications than with external dacryocystorhinostomy, which is why virtually all procedures have been done endoscopically for many years.

Surgery

Previous examinations

Before performing the surgery, several tests are carried out:

• Complete ophthalmological examination and examination of the eyelid and periocular area.
• Irrigation of the lacrimal duct in consultation, which entails injecting a saline solution under pressure into the lacrimal duct, which makes it possible to locate the obstructed area.
• Dacryoscintigraphy: it is a functional contrast test of the tear ducts that needs to be performed in some cases.

Before the surgery

Do not take blood thinners or aspirin before surgery.

During the surgery

Dacryocystorhinostomy is performed on an outpatient basis under local anaesthesia and sedation. There is no need for hospital admission.
During the surgery, silicone tubes are placed in the tear duct temporarily. These act as a “mould” for the new tear duct, so that the tear can drain correctly at the end of the postoperative period.

Postoperative period

The operated eye is occluded for 24 hours, after which the surgeon checks the patient.
The patient must follow an oral and topical antibiotic and anti-inflammatory treatment.

In two weeks, the surgeon consults with the patient again to assess and control the correct healing and patency of the tear duct.

The final results of dacryocystorhinostomy can be seen one and a half months after surgery.

Frequently asked questions

• Why can dry eye cause a watery eye at the same time? Because when there is dry eye, it occurs in the conjunctiva and the cornea that produce secondary, reflex tearing.
• Why do our eyes water when we experience visual fatigue? Because the blink rate goes down and, therefore, dries the eye and produces reflex tearing like dry eye
• Should you see a doctor if your eyes water? Yes, without a doubt, because it may be the first symptom of some pathology.
• Does conjunctivitis always cause a watery eye? Yes, it is an irritation, and there is a hyperaction of the glands of inflammatory origin.
• What happens if tear obstruction is not treated A watery eye greatly reduces quality of life. Improving this is a very important reason, but if it is not corrected, stagnant tears and recurrent conjunctivitis occurs. It subsequently causes infections in the lacrimal sac, acute or chronic dacryocystitis.