What is DCR surgery?
Dacryocystorhinostomy, commonly referred to as DCR surgery, is a procedure that creates a new opening between the tear sac and the nasal cavity to allow tears to drain normally when the natural tear drainage pathway is blocked or too narrow to function adequately. Rather than attempting to reopen a blocked channel, DCR bypasses the obstruction entirely by establishing a new, direct route for tears to travel from the tear sac into the nose.
Under normal circumstances, tears drain from the surface of the eye through small openings at the inner corner of the eyelids, into the tear sac, and then down through the nasolacrimal duct into the nasal cavity. When the nasolacrimal duct becomes narrowed or completely blocked tears have nowhere to go and overflow onto the face. In some cases, stagnant tears within the blocked system lead to recurrent infection of the tear sac, known as dacryocystitis.
Who needs DCR surgery?
DCR surgery is recommended for patients whose tear drainage symptoms have not resolved with conservative management and whose obstruction is located at the level of the tear sac or nasolacrimal duct. Common indications include:
- Persistent excessive tearing caused by a complete or significant nasolacrimal duct obstruction
- Recurrent infections of the tear sac caused by an underlying blocked tear duct
- A tear sac abscess that has developed as a result of chronic obstruction and infection
- Chronic dacryocystitis that has not responded to antibiotic treatment alone
- A mucocele — a fluid-filled swelling of the tear sac caused by complete obstruction of the drainage system
Failed prior tear duct procedures such as probing or balloon dilation that have not provided lasting relief
What should I expect during DCR surgery?
Prior to surgery, you will meet with your oculofacial plastic surgeon for a comprehensive evaluation. During this appointment, your surgeon will:
- Assess the tear drainage system through probing, irrigation, and clinical examination to confirm the location and degree of the obstruction
- Review imaging studies of the drainage system if obstructed
- Evaluate the nasal cavity for any structural abnormalities that may affect the surgical approach
Discuss which surgical approach is most appropriate for your situation
DCR surgery is performed as an outpatient procedure and patients go home the same day. It is typically performed under general anesthesia, though local anesthesia with sedation may be used in select cases.
There are two surgical approaches to DCR:
- External DCR is performed through a small incision made on the side of the nose, just alongside the inner corner of the eye. Through this incision, the surgeon accesses the tear sac and the adjacent nasal bone, creates a small opening through the bone, and forms a new connection between the tear sac and the nasal cavity. The new opening is secured and a small silicone tube is passed through the drainage system to serve as a stent while the new pathway heals. The external incision is closed with fine sutures and typically heals with minimal visible scarring.
- Endoscopic DCR achieves the same result entirely through the nasal cavity using a small camera and specialized instruments, without any external incision. The surgeon works from inside the nose to create the new opening between the tear sac and the nasal cavity. Because there is no external incision, there is no visible scar on the skin.
In both approaches, a small silicone tube is threaded through the new drainage opening and left in place for several weeks to months while the new pathway matures and heals. The tube is then removed in a simple, brief office procedure.
What should I expect after DCR surgery?
Recovery from DCR surgery is generally well tolerated. Most patients are able to return to light daily activities within a few days, with full healing of the new drainage pathway taking several weeks to months.
In the first several days following surgery, it is normal to experience:
- Swelling and bruising around the inner corner of the eye and alongside the nose
- Mild to moderate nasal congestion or a sensation of fullness in the nose
- Some blood-tinged nasal discharge in the first day or two following surgery
- Mild discomfort at the incision site for external DCR
- Awareness of the silicone tube at the inner corner of the eye, which may be faintly visible
The silicone tube is typically removed between six weeks and three months after surgery in a brief, well-tolerated office procedure. Most patients notice a significant reduction in tearing once the new drainage pathway is functioning and the tube has been removed. Final results continue to improve as the new opening fully matures.
What are the risks of DCR surgery?
DCR surgery is a well-established procedure with high long-term success rates when performed by a surgeon with specialized experience in tear drainage surgery. As with any surgical procedure, there are potential risks to be aware of:
- Bleeding during or after surgery, including nosebleeds in the post-operative period
- Infection at the surgical site or within the nasal cavity
- Scarring that narrows or closes the new drainage opening over time
- Failure of the procedure to relieve tearing, which may require revision DCR surgery
- Premature displacement or loss of the silicone tube before the new opening has fully healed
- Granuloma formation around the silicone tube
- For external DCR, a visible scar alongside the nose, though this typically fades significantly over time
- Injury to surrounding structures including the nasal mucosa or orbital tissue
- Nasal symptoms including altered sensation or changes in nasal airflow
- Recurrence of obstruction or dacryocystitis requiring repeat surgery
A blocked tear duct that is causing persistent tearing or recurring infections is not something that resolves on its own in adults. DCR surgery addresses the problem definitively by creating a new drainage route that works the way your natural system was always meant to. The oculofacial plastic surgeons at The Iowa Clinic specialize in tear duct surgery and will guide you through every step from evaluation to recovery. Call 515.875.9480 to schedule an appointment.