Dacryocystorhinostomy (pronounced dak-ree-o-sis-toe-ry-nost-o-mee), or DCR,
is a surgery performed to correct a blocked or obstructed tear duct. The tear duct is a passageway from the eye to the nose
that facilitates the drainage of tears.
Tears are essential to lubricate and
protect the health of the eye. With each blink, the eyelids act as windshield wipers, evenly spreading tears across the eyes’
surface. The tears then drain into small openings on the inside corner of the eyelids, called puncta and travel to the lacrimal
sac. From the lacrimal sac, they flow through the lacrimal duct and empty into the nose. If tears become trapped in the lacrimal
passageway there is a risk of infection. A DCR can be performed to correct this problem.
What
Are the Symptoms of an Obstructed Tear Duct?
If the tear passageways
become blocked, tears cannot drain properly and may overflow from the eyelids onto the face as if you were crying. In addition
to excessive tearing you may also experience mucous discharge, eye irritation, and painful swelling in the inner corner of
the eyelids. A thorough examination by an ophthalmologist can determine the cause of tearing and recommended treatment.
How is an Obstructed Tear Duct Treated or Repaired?
Depending on your symptoms and their severity,
your specialist will suggest an appropriate course. In mild cases, a simple treatment of warm compresses and antibiotics may
be recommended. In more severe cases, DCR surgery is the most effective treatment. A DCR is performed by creating a new tear
passageway from the lacrimal sac to the nose, bypassing the obstruction. A small incision is made either in the skin or inside
the nose. A small silicone tube called a stent may temporarily be left in the new passageway to keep it open during the healing
process.
In a small percentage of cases, the obstruction is between the puncta
and the lacrimal sac. In these cases, in addition to the DCR procedure, the surgeon will insert a tiny artificial tear drain
called a Jones Tube. A Jones Tube is made of Pyrex glass and allows tears to drain directly from the eye to the lacrimal sac.
Where
is the Surgery Performed?
DCR surgery is usually performed as an outpatient procedure
under local anesthesia. There is very little postoperative discomfort and any bruising and swelling subside in one to two
weeks. Most patients experience an immediate resolution of their tearing and discharge problems once surgery and recovery
are completed.
Who Should Perform DCR Surgery?
When choosing
a surgeon to perform a dacryocystorhinostomy or DCR, look for an ophthalmic plastic reconstructive and cosmetic surgeon who
specializes in the tear drain system, orbit and eyelids. It’s important that he or she has completed an American Society
of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) fellowship. This indicates your surgeon is not only a board certified
ophthalmologist who knows the anatomy and structure of the tear drain system, orbit and eyelids, but also has had extensive
training in ophthalmic plastic and cosmetic surgery. Dr. Shorr is Director of the Fellowship in Ophthalmic Plastic Reconstructive
and Cosmetic Surgery at the Jules Stein Eye Institute, UCLA School of Medicine. He and his associates are board certified
ophthalmologists as well as ophthalmic plastic and cosmetic facial surgeons who have completed an ASOPRS fellowship.
