Having Dacryocystorhinostomy

A dacryocystorhinostomy (DCR) is a type of surgery. It’s done to create a new tear duct between your eyes and nose. You may need this surgery if your tear duct has become blocked.

What to tell your healthcare provider

Tell your healthcare provider about all the medicines you take. This includes over-the-counter medicines such as ibuprofen. It also includes vitamins, herbs, and other supplements. And tell your healthcare provider if you:

• Have had any recent changes in your health, such as an infection or fever

• Are sensitive or allergic to any medicines, latex, tape, and anesthesia (local and general)

• Are pregnant or think you may be pregnant

Tests before your surgery

Before your surgery, you may need imaging tests. These may include:

• CT scan of your nasal passages

• MRI scan of your nasal passages

If there is a blockage in your tear duct, a few more tests may be done, such as:

• Nasoendoscopy. This test looks at your nasal and sinus passages. It helps to see any deviation in your nasal septum. It can also find any problems that may affect the surgery.

• Fluorescein dye disappearance. Special drops are put into your eyes to check tear flow.

• Irrigation of the lacrimal system. This test helps to find and assess how bad the blockage is.

Getting ready for your surgery

Talk with your healthcare provider about how to prepare for your surgery. You may need to stop taking some medicines before the procedure, such as blood thinners and aspirin. If you smoke, you may need to stop before your surgery. Smoking can delay healing. Talk with your healthcare provider if you need help to stop smoking.

Also make sure to:

• Ask a family member or friend to take you home from the hospital. You can't drive yourself.

• Follow any directions you are given for not eating or drinking before your surgery.

• Follow all other instructions from your healthcare provider.

You will be asked to sign a consent form that gives your permission to do the surgery. Read the form carefully. Ask questions before you sign the form if something is not clear.

On the day of your surgery

Your surgery will most likely be done by a healthcare provider trained in ophthalmic plastic surgery. They will work with a team of specialized nurses. The surgery can be done in several ways. Ask your provider about the details of your surgery. In general, you can expect the following:

• You may have general anesthesia. This will cause you to sleep through the surgery and not feel pain. Or you may be awake during the surgery. You may get a medicine to help you relax.

• Small sponges or other materials will be put inside your nose. These have anesthetic on them to prevent pain during the surgery. They may also have medicine to help decongest your nose and make you bleed less during the surgery. You may also have a shot to numb the area.

• The eye care provider may make a small cut (incision) below or near your eyelid. This is done under your eye and next to your nose. Or the provider may enter through your nose instead of using an incision below or near your eyelid.

• The provider will make a small hole in the bone in this area. This makes a new opening between the lacrimal sac and your nose. In some cases, a small tube (stent) may be put into the opening. This is to help keep the new tear duct open.

• The provider may close the incision with stitches (sutures).

After your surgery

Ask your healthcare provider what to expect after your surgery. Your nose may be refilled with packing material to reduce your chance of bleeding. You may be able to go home the same day. Plan to have someone go home with you after the procedure.

Plan to have someone drive you home after your surgery.

Recovering at home

Follow your healthcare provider’s instructions about caring for your eye, nose, and incision. The area may be a little sore after the surgery. You may be able to take over-the-counter pain medicine. It is normal to have some bruising around the area.

You may need to take antibiotics to prevent infection. Your healthcare provider may also give you instructions for rinsing your nose. You may also need to take other medicines. These may include steroid-based nasal sprays and nasal decongestants.

Ask your healthcare provider if you should avoid certain activities while you recover.

Follow-up care

You will need follow-up care to see how well the surgery worked. You may have an appointment the day after the surgery. If you have a stent, you may need to have it removed a few months later. Make sure to keep all your follow-up appointments.

When to call your healthcare provider

Call your healthcare provider if you have any of the following:

• Fever of 100.4°F (38°C) or higher, or as directed by your provider

• Excess bleeding

• Pain or swelling that does not get better with pain medicine or gets worse