Endoscopic DCR: Treatment, Procedure, Cost and Side Effects

Dacryocystorhinostomy or Endoscopic DSR can be defined as the performance of a procedure for the purpose of treating epiphora (tearing) which occurs due to the blockage of nasolacrimal duct. The lacrimal gland is located at the upper outer margin of the eye where tears originate. With each blink, the tears cross the eye. They are then directed into small openings in the eyelids known as puncta. From this point onward, the tears travel into the lacrimal sac through a pathway called the canalicular system. The location of the lacrimal sac is between the eyes and the nose. Through the nasolacrimal duct it funnels tears into the nasal cavity. There can be many causes of excessive tearing as this is quite a long passage of tears to pass. Blockage of nasolacrimal duct is a very common problem and can be treated by the creation of a direct opening into the nasal cavity from the lacrimal sac. This procedure is known as DCR. An ophthalmologist and an otolaryngologist are involved in carrying out this procedure.

The reason why DCR is indicated in treating tearing is because of nasolacrimal duct obstruction. Blockage of this duct occurs due to many reasons like inflammatory medical conditions, prior surgery, tumor, or trauma, but mostly due to an unidentifiable cause.

Usually, the surgery is performed under general anesthesia, but it may also be performed under local anesthesia according to the surgeon or patient’s preference. DCR can either be achieved through an endoscopic approach (usage of instruments and a small telescope through the nasal cavity) or from an endoscopic approach (usage of a small facial incision). This procedure aims at the bypass of obstructed nasolacrimal duct and allowing tear drainage into the nasal cavity directly from the lacrimal sac. Endoscopic DCR approaches the nose and performs the surgery through a telescope and small instruments. This approach of DCR has now become a commonly used procedure as it avoids a facial scar and is also associated with less pain. External DSR does the same, but the only difference is that it approaches the lacrimal sac through a small facial incision and performs the surgery between the eye and the nose. The lacrimal sac is then identified and opened into the nose. In order to maintain the opening, stents or sutures are used by the surgeon. Only on the basis of extensive anatomic study is the location of lacrimal sac known. This procedure involvesthe removal of bone from over the lacrimal sac and then it is opened into the nasal cavity.

The side effects associated with Endoscopic DCR are nasal bleeding, swelling, bruising, and infection.

As soon as the operation is over, you will have your breathing, wounds, blood pressure and pulse checked on a regular basis by a nurse. You will feel drowsy for several hours post treatment. You will be given an oxygen mask to breathe properly until you are fine and can breathe comfortably on your own. Anesthetics are known to make people sick. Hence, you will offered an injection by a nurse to make the feeling of sickness go away and this will definitely help in settling it. You will feel that a drip is running in the vein of your hand. This will continue until you can eat and drink again. You will require no stitches and dressing after the operation. It is safe to expect some bruising and swelling after the operation. Simple painkillers like Paracetamol will help with the mild pain that you may face after the operation. There will be a stay period of one night in the hospital post surgery. You can then go home.

Bruising and swelling last for about a couple of weeks. Total recovery takes approximately 6 weeks.

Yes the results of the treatment are usually permanent.

There are many alternatives available of Endoscopic DCR. These include therapeutic probing, punctual irrigation, steroid eye drops, antibiotics, balloon dilatation, and stenting.