Tear duct surgery (dacryocystorhinostomy)

This procedure has been around for many years and aims to relieve a watery, sticky eye caused by a blockage of the passageway (nasolacrimal duct) situated between the tear (lacrimal) sac at the inner corner of the eye and the back of the nose. A small amount of bone on the side of the nose is removed to allow a direct connection to be fashioned between the opened tear sac and the lining of the nose. The blockage lower down is therefore bypassed, allowing tears to drain freely again into the nasal cavity. Usually soft silicone tubes are placed during the procedure to stent the new opening and increase success rate; these are generally easily removed 6-8 weeks later in the out-patients.

There are two methods of achieving this:

1. External approach via a small incision on the side of the nose (External DCR)

2. Internally through the nose using a small telescope with a light (Endoscopic DCR)

Small scar on the left side of the nose 5 days following an external DCR

The optimum technique in any particular situation is governed by several factors eg exact location of the blockage, but generally there is approximately an 85-90% success rate for both approaches. Any patient with a suboptimal result can often be improved with a second procedure. The lacrimal surgery can be performed under general anaesthesia or local anaesthetic with sedation, the choice often depending on other factors such as general health. Many patients have this operation as a day-case procedure but there are circumstances where an overnight stay in hospital is required.