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Dacryocystorhynostomy (DCR)


What is DCR?

DCR, or dacryocystorhinostomy, is a surgery performed to create a new tear drain between the eye and nose when your current tear drain becomes blocked or obstructed.

Anatomy

The tear drain consists of two small openings called punctum; one in your upper eyelid and the other in your lower eyelid. Each of these openings leads into a small tube called the canaliculus which, in turn, empties into the lacrimal sac between the inside corner of your eye and your nose. The lacrimal sac leads into a canal called the nasolacrimal duct that passes through the bony structures surrounding your nose and empties tears into your nasal cavity.

What are the Symptoms of Having a Plugged and Infected Tear Drain?

The most common symptoms are excessive watering, mucous discharge, eye irritation, and painful swelling in the inner corner of your eyelids. A skillful history and physical examination can usually pinpoint the cause of tearing. If your symptoms go untreated, an infection can develop around your eye.

What are the Treatments?

Your surgeon may recommend a number of treatments based on the analysis of your symptoms. In some instances, it may be as simple as applying warm compresses and antibiotics, but often, surgery is the most effective treatment. The most common surgical solution is the dacryocystorhinostomy. Since its introduction in the early 1900s, the procedure has the highest success rate (more than 90%) for adults who have not had prior nasal surgery or disease. To perform the procedure, your surgeon will create a new tear drain opening from the blocked sac directly into your nose to bypass the obstruction. A small incision is made either in the skin or inside the nose. A fi ne, soft silicone stent may temporarily be left in the new tear drain (for between oneto- six months after surgery) to keep the duct open while healing occurs. If the obstruction cannot be opened, it may be necessary to surgically place a tiny artifi cial drain called a “Jones tube” behind the inner corner of the eyelids. The tube is made of Pyrex glass and remains permanently in the tear duct.

Dacryocystorhinostomy surgery is usually performed as an outpatient procedure. It may be done under local anesthesia, with the patient sedated with intravenous medications, or under general anesthesia, in which case the patient will sleep through the operation. You may need to use antibiotic ointment or drops after surgery. Recovery time is generally one week.
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