Tears normally drain through small openings in the corners of the upper and lower eyelids (puncta) and enter the nose through the nasolacrimal duct. When the tear duct is blocked, tears cannot drain normally, causing a backflow of tears and discharge from the eye. The blockage can be due to trauma, prior surgery, tumor, or inflammatory medical conditions, but often there is no identifiable cause. If the excessive tearing is bothersome and interferes with normal life, an endoscopic dacrycocystorhinostomy (DCR) may be an option for treatment. This procedure creates a direct path from the lacrimal sac to the nose, bypassing the blocked nasolacrimal duct.
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. Not everyone who has a blocked tear duct needs a DCR. A DCR is a much more common treatment for adults than for children. Your healthcare provider might first recommend less invasive treatments. These may include warm compresses, massage, and antibiotics for an infection. Or a healthcare provider might advise a procedure to try to dilate the nasolacrimal duct. If your symptoms are severe, however, you may need a DCR.
To treat tearing related to blocked nasolacrimal duct.
An external dacrycocystorhinostomy is performed with an incision in the skin on the side of the nose, close to the eye. Some bone is removed so a tube can be inserted through the lacrimal sac and into the nose. This tube is then left in place to prevent the gap from closing and is removed after a few months.
Before your doctor decides that a dacrycocystorhinostomy is the best option for your condition, there are a number of eye-related exams that can be carried out, including probing and irrigation of the tear system and the use of dye in the tears to observe how long it takes for the eye to clear it. Specific preparation for the procedure will depend on the type of anesthesia used. If general anesthesia is used, you may need to undergo a physical examination, blood tests, chest x-ray, and an electrocardiogram (EKG). You will also need to avoid food and water for six to eight hours before the procedure or as recommended by the doctor. Please plan to stay in Thailand for at least one week through the duration of treatment. It is recommended that you stay in a hotel close to the hospital for convenience in traveling to the hospital before and after the procedure. You will undergo a health screening when convenient for you before the procedure as the procedure is done using general anesthesia. You will likely need to fast before the health screening. You will be given detailed instructions by your medical team.
If general anesthesia was used, you will need to be observed in a recovery area for a couple of hours after the procedure, until the anesthesia wears off. You will likely be able to go home the same day. You will be given medication to manage pain as well as prevent infection (oral or topical for the eye). Please keep all scheduled follow-up visits with your doctor. If a stent was placed, you will be scheduled to have it removed as determined appropriate by your doctor.
Some possible risks of this procedure include:
-Abnormally fused tissue in the nose
-Displacement of the stent placed in the duct
-Prominent facial scar
-There is also a risk that the DCR will not be effective.
Your risks may differ according to your age, your other health conditions, the type of DCR performed, and the reasons for it. Talk with your doctor about all your concerns and about the risks that are most applicable to you.
Can I travel after the procedure?
The doctor will schedule a follow-up appointment for the day after the procedure. If you have no abnormal symptoms after the procedure, you can usually return to your home country. The final decision will depend on your doctor’s recommendation. After the follow-up appointment the day after the procedure, you will need to see your doctor one month after the procedure, three months after the procedure, and six months after the procedure. If you cannot return to Thailand for these appointments, please see an ophthalmologist in your home country.
What is the likelihood for success?
The success of the procedure depends on the blockage of the nasolacrimal duct. Your doctor will investigate and explain this to you.
What will happen if this procedure is not done?
Excessive tearing can impair vision and a blocked nasolacrimal duct can lead to infections of the eye.