This operation is necessary when the main tear drainage tube is blocked and as a result stops tears flowing from the eye into the nose.
A dacryocystorhinostomy (DCR) operation can be performed either by going into the nose, using a very small camera and making a new route for the tears to drain into the nose from the tear sac or alternatively by performing the same operation from the outside and going into the nose through a cut in the skin. These two variations of the DCR operation are called an endonasal DCR and an external DCR respectively.
Mr McLean performs both of these types of DCR operation. The endonasal DCR operation is a good choice if the nasal space allows proper access to the camera and instruments. If it is not possible to carry out an endonasal DCR due to restrictions in access then an external DCR is carried out. Although this approach requires a skin incision on the side of the nose, this heals very well in the vast majority of cases leaving only a very fine incision line.
The operation is usually performed under a general anaesthetic but it is possible to use a local anaesthetic if required. There may be some bleeding from the lining of the nose during the operation and because of this it is necessary to stop or reduce any medications that may thin the blood (such as aspirin, ibuprofen or warfarin). Mr McLean will advise you about this before surgery takes place.
During the operation a very thin piece of silicone tubing is threaded through the tear duct openings in the upper and lower eyelids. The two ends are then tied so that they lie inside the nose. This tubing or lacrimal stent, stays in place while the new opening into the nose is healing and helps to prevent the new opening from closing over. Once the healing process has finished the stent can be simply removed in the clinic.
After the operation you will be given antibiotic eye drops to use for the eye as well as a nose spray. This treatment is continued for four weeks after surgery. The nurses on the ward will give you instructions about these medications before you are discharged from hospital.
Complications after surgery include nose bleeds (these are usually very mild but may continue for a few days), infection of the surgery site (the use of antibiotics during the operation and antibiotic eye drops afterwards makes this complication rare). The silicone tubing stent can occasionally make the eyelids feel uncomfortable. If this is the case then the stent can be removed earlier than planned. The operation is never successful in every single case as the formation of scar tissue around the new drainage opening inside the nose can sometimes compromise the flow of tears. If this happens then further surgery is needed to remove any excessive scar tissue.