External Dacryocystorhinostomy or DCR is a commonly done lacrimal surgery which is performed for the restoration of the tear flow into the nose from the lacrimal sac, which occurs when the nasolacrimal duct or the tear duct gets obstructed (Blocked tear duct / Tear Duct Obstruction Blockage).
Abnormal tearing or Epiphora or excessive Watering of Eyes takes place when the tear duct becomes obstructed. This disables normal tear drainage into the nose. Due to stagnation of tears, infections may occur frequently. The Dacryocystorhinostomy surgery, which includes fistulization or the process of creating a direct opening of the lacrimal sac directly into the nasal cavity, may help in alleviating the symptoms. The surgical approach to the sac may be external/traditional or endoscopic Dacryocystorhinostomy. Rigid telescopes or the microscope may be used in the latter approach.
Types of Approaches:-
- External/Traditional: – On the lateral side of the nose or medial side of eye a small incision is made and a small piece of bone is removed to make a bridge to the nose. The drains are left behind and removed after sometime so that the gap does not close. Silicone intubation may be placed such that the tear flow from the nose to the eyes takes place easily.
- Endoscopic: Endoscopic Dacryocystorhinostomy approach can also be utilized for this surgery. In this method, there are no external incisions so that no scar is visible. The surgery is performed through the nose, where an opening is made in the lacrimal sac, from inside the nose. Success rates of endoscopic Dacryocystorhinostomy (DCR surgery) are much lower to external Dacryocystorhinostomy.
Symptoms for Dacryocystorhinostomy (DCR Surgery):-
- Chronic Dacryocystitis (which happens due to inflammation of nasolacrimal sac with purulent drainage
- Abnormal tearing or watery eyes which are caused by functional blockage of nasolacrimal duct.
- inflammation of skin in the medial canthus
- Presence of a benign lacrimal sac mass
- Atopic rhinitis is an outright contraindication.
- In case of patients above the age of 70, Dacrocystectomy may be preferred to Dacryocystorhinostomy, as natural atrophy of nasal mucosa may be caused due to old age.
Procedure for Surgery:
Generally the procedure is carried out under general anesthesia..
- While opening the sac, injury/trauma to the internal opening of the common canaliculus may occur
- Possibility of Hemorrhage can be minimized by adequate anesthetic vasoconstriction, cautery, and bone wax. Excessive cauterization of the nasal mucosa that could induce scarring should be avoided.
- The canaliculi may be injured due to improper poking.
- Cerebrospinal fluid leakage may occur because of penetration of the cribriform plate
- Due to improper bone removal, lateral nasal mucosa may have to be cut.
- Orbital contents may be injured due to drilling.
- Lacrimal sac diverticulum may not be completely drained and removed.
- The inferior portion of the lacrimal sac may not be opened completely.
- Early loss of the silicone tube
- Unsatisfactory results
- Synechiae (a condition wherein the eye adheres to either the cornea or the lens) between the middle turbinate, nasal septum, or lateral wall
- Fibrosis occlusion of the ostium
- Need for more surgeries
Prognosis & Results:-
90-95% success rate is achievable with external Dacryocystorhinostomy surgery approach, which remains the gold standard & the best treatment for tear duct blockage. The prognosis is excellent.