Dacryocystorhinostomy (DCR) Procedure (Treatment for a Blocked Tear Duct)

Introduction

Tears are produced in a gland under the skin above the eye. This tear fluid flows over the surface of the eye and drains away through tiny tear ducts known as puncta, situated in the inner corner of the eyelid to the inside of the nose. If your eyes continuously water due to a blocked tear duct, or feel gritty, dry and uncomfortable, or you are prone to frequent eye infections, then this operation may be of benefit.

There are some conditions that increase tear production. These include:

• Something irritating your eyes, such as an allergy or eyelash
• Thyroid eye disease (this is an unusual cause).

Many people with watery eyes have a combination of overactive tear production and blocked tear ducts.

What does the operation involve?

You will need to complete a pre-operative health questionnaire and may be required to attend a pre-operative assessment prior to being given a date for surgery. During this visit you will be asked personal questions about your general health. Various blood tests and a recording of your heart rate (ECG) may be taken, and a full assessment made to ensure that you are in the best possible health prior to your surgery. Medication adjustment may be necessary if you are on anti-platelet or anti-coagulant therapy, and the Pre-operative Assessment team should provide you with relevant advice.

The day of the operation

Most patients will be admitted on the day of surgery to the Eye Day Case Unit or Surgical Admissions Lounge. Both departments are situated on East Wing, Level 2. The nurse will complete routine paperwork and record your vital signs (blood pressure, pulse rate, respiration rate and temperature). You will be asked to change into a theatre gown in preparation for your surgery.

The anaesthetic

The anaesthetist will discuss the various options available to you, including risks as well as benefits. They will suggest the most suitable option, taking into account your general health and medical history. This procedure is normally performed under a general anaesthetic as a day case procedure.

The operation

This is called an external DCR. A small incision is made on the skin on the side of the nose to gain access to the tear sac. A small piece of bone between the tear sac and the nose is removed. A new channel is formed, and soft flexible tubes (stents) inserted to keep the channel open. The tubes remain in place for a few months to prevent the new channel from closing over. These are usually removed after six to eight weeks in the outpatient department. The sutures are removed after seven to ten days. The scar fades over time and is usually undetectable after six months.

Endoscopic DCR can also be performed using a thin, flexible, fibre optic telescope called an endoscope. This is passed up your nose and guides instruments or a laser which is used to make a hole in your nose bone. This method has the advantage of leaving no scar on the side of the nose.

After the operation

After a period in the recovery area, you will be transferred to a ward. You may be aware of the nurse assessing your wound site and recording your pulse and blood pressure at intervals. To manage your discomfort, regular analgesia is advised. You may notice spots of blood from the nose and facial bruising. A nosebleed may occur on the affected side thus requiring a nasal pack to be inserted to stem the blood flow, and a pressure pad placed over the site of the operation to reduce the bruising. You should be able to start eating and drinking the same day.

Your discharge from hospital

You will need to have pre-arranged for someone to collect you upon your discharge, and a responsible adult to stay with you for a full 24 hours post-operatively.

What should I do when I leave hospital?

Activity

Due to the surgery, the eye is prone to infection, so you should:

• Take things easy for the first few days
• Take regular pain relief as required, and in line with manufacturer’s instructions
• Not rub the wound even if it is itching
• Avoid any strenuous exercise
• Avoid forcefully blowing your nose for one week after your procedure. After that you are encouraged to gently blow your nose to clear the blood clots
• Sneeze with your mouth open
• Avoid air travel for seven days after surgery
• NOT wear eye or facial make up for two weeks after surgery
• Follow the advice of your surgical team on when you can retake your anti-platelet or anti-coagulant therapy
• Avoid homeopathic medicines that promote fast healing
• Avoid swimming for two weeks.

The ward will make any future out-patient clinic appointments that may be required. They will also inform your GP surgery of the operation carried out. If you have any worries, please contact your GP or see the Further Information and Advice section for contact numbers following your surgery.

Work
Your own circumstances will determine when you feel ready to go back to work, although most patients require two weeks off. If your period of time off sick is greater than one week, please ask the surgeon to complete a fit certificate.

Wound after care
The eye(s) may look red, and you could have facial bruising. This will subside over a 14-day period. If you have been prescribed eye drops, topical ointment or antibiotics, it is important that you follow the instructions and complete the course as directed. Some patients are also prescribed a steroid nasal spray to use twice daily. Following this procedure, it is not uncommon for you to experience a certain amount of discomfort. This is to be expected.

Are there any risks involved in this operation?

Although modern surgery and anaesthetics are considered to be safe, all medical procedures carry some risks. The surgeon will discuss these risks and benefits of the procedure with you.

Risks associated with the operation are:

• Possibility of failure
• Tube displacement
• Bleeding
• Infection.

Risks associated with general anaesthetic are:

• Blood clots in the legs (deep vein thrombosis) that can travel to the lungs (pulmonary embolism). Depending on your medical history, you may be asked to wear thrombi-deterrent stockings to assist venous return in your legs and help prevent blood clot formation
• Chest infection.

Are there any alternatives to this operation?

Unfortunately, there are no alternative procedures to this operation.

What could happen if I do not have the operation?

In order to decide, you need to have information and alternative approaches from health-care professionals about the treatment or investigation which is being offered to you. Your understanding is crucial. If you decline to take up the offer of surgery, your condition will remain or at worst, become more troublesome to you.

Further information and advice

We hope you have found the above information useful, but for more help and guidance, please call 01305 255779.

You can also contact:

NHS 111 or visit https://111.nhs.uk

Patient Experience team: 0800 7838058 or patientexperience@dchft.nhs.uk

The Patients Association: 0800 3457115 or visit www.patients-association.org.uk 

Royal College of Anaesthetists: www.rcoa.ac.uk   

About this leaflet

Author: Christine Lush, Registered General Nurse, Surgical Admissions Lounge
Written: January 2022
Updated and approved: February 2023
Review date: February 2026
Edition: v2

If you have feedback regarding the accuracy of the information contained in this leaflet, or if you would like a list of references used to develop this leaflet, please email patientinformation.leaflets@dchft.nhs.uk