Constant watery eyes due to blocked tear ducts not only make it difficult to get through normal activities and everyday life, but can as well be the cause of a variety of other eye-related diseases and disorders. Patients with blocked tear ducts will experience excessively watery eyes to the point that they will need to constantly wipe their eyes. As a result, contaminants often remain in the eyes, and the trapped bacteria can lead to infections, which cause abscesses and discharge. This also creates the risk of a bacterial infection spreading into the eyes and the tissue surrounding the eye sockets, as well as a wide variety of other diseases, such as chronic conjunctivitis, keratitis, and blepharitis (chronic inflammation of the eyelids) – which can cause eyelashes to grow abnormally or fall out, and is a constant source of itchiness and irritation.
A DCR procedure is done to relieve the symptoms of a blocked tear duct. These include excessive eye watering or crusting around your eye. If the duct is infected, you might have symptoms such as; swelling and tenderness around your eye, eye irritation and mucous discharge.
-It is a safe, effective, low complication technique that yields good esthetical-functional results and that it shows a success rate similar to that of external approach when performed by experienced surgeons.
This type of surgery employs the use of a microscopic camera known as an endoscope and other instruments which are inserted through the nasal opening to the tear duct system. Surgery can then be performed to create a pathway for drainage from the eye to the inside of the nose. This method uses flap suturing techniques to create a new, direct and permanent passage way between the lacrimal sac and the nose. This new route bypasses the duct that empties into the nose,, which is the most common site of blockage, and allows tears to drain directly into the nasal cavity. A silicone stent is then inserted and can be left in the nasal vestibule, to be removed approximately four weeks later.
In order to ensure that a patient’s watery eye symptoms are indeed due to blocked tear ducts, the ophthalmologist will carry perform a lacrimal irrigation to confirm this. The procedure includes the following steps: -Topical anesthetic is administered to the patient’s eye. -The doctor dilates the puncta. -Irrigation (flushing sterile liquid through the duct and into the nose) is then carried out to ensure the duct is open and that any blockage has been removed. Your doctor may also want certain tests before the procedure to get a better idea of your anatomy. These might include: CT and MRI scans of your nasal passages
In cases where the patient’s lacrimal system is functioning normally, the sterile fluid will pass freely through to the nose. The patient will have a salty or bitter taste in the back of their throat. If, however, the patient’s tear duct is restricted or blocked, the liquid will be unable to drain down freely or may flow slower than normal, and there will be regurgitation of the liquid through the punctum. This method, in addition to confirming the cause of the condition, can also help to determine the location of the blockage, indicating whether the blockage is in the nasolacrimal duct, the puncta, or the lacrimal sac. It can also help to identify the degree of the blockage as well. After endoscopic DCR surgery (which should take approximately 45 minutes to 1 hour), the patient is recommended to stay in the hospital overnight in order to sleep off the effects of the anesthesia. Some patients may experience a slight swelling or bruising and may feel as if they have a cold for about 3-5 days. Doctors will usually prescribe antibiotic medication to be taken for approximately one week following surgery, along with eye drops and nasal spray to help cleanse the eyes and nose. They can be self-administered at home and are required to be used for about one month following surgery. An eye patch is not required for the patient to wear at home.
Complications are fairly uncommon with an endoscopic dacrycocystorhinostomy, but may include:
-Pain, which is usually well controlled with medication.
-Scarring within the nose, leading to blockage of the opening and recurrence of excessive tearing.
-Extremely rare is the risk of bleeding within the orbital cavity or injury to the eye.
-Reaction to general anesthesia.
What happens after the procedure?
Ask your doctor about what you should expect after your surgery. You may need to have your nose refilled with packing material to reduce your chance of bleeding. In most cases, you will be able to go home the same day. Plan to have someone go home with you after the procedure. Be sure to follow your doctor’s instructions about caring for your eye, nose, and wound. You may need to take antibiotics to help prevent infection. Your doctor may also give you instructions about rinsing your nasal cavity. You may also need other medicines, like steroids and nasal decongestants. The area may be a little sore after the procedure, but you should be able to take over-the-counter pain medicines. It is normal to have some bruising around the area. Ask your doctor whether you should avoid any specific activities while you recover. You will need close follow-up care with your doctor to see whether the surgery was effective. You may have a scheduled appointment the day after the procedure. You will need continued follow-up care to monitor how you are doing after your surgery. If you had a stent placed, you may need to have it removed a few months later. Tell your doctor right away if you have excessive bleeding, fever, or increasing pain or swelling.