Surgeries of the Nose & Sinus
Endoscopic DCR Surgery
Endoscopic Dacryocystorhinostomy (DCR) is a minimally invasive procedure used to bypass the nasolacrimal (tear) duct. It can be performed using either surgical instruments or a laser and is associated with potentially faster recovery and fewer external scars.
The blockage of the nasolacrimal duct can lead to persistent tearing (epiphora) due to inadequate drainage of tears into the nose. The surgery creates a new drainage pathway for tears from the lacrimal sac into the nasal cavity, bypassing the blocked portion of the nasolacrimal duct.
DCR surgery is also indicated for individuals with recurrent or chronic dacryocystitis (infection of the lacrimal sac) and congenital nasolacrimal duct obstruction that does not resolve spontaneously.
The endoscope is inserted through the nasal cavity to visualise and access the lacrimal sac and nasal bones. The bone is drilled away endoscopically, and a similar new pathway is created without external incisions. A mucosal flap is created to line the new passage connecting the lacrimal sac to the nasal cavity, ensuring proper drainage of tears. Silicone tubes or stents may be placed temporarily to keep the new pathway open and aid in healing.
DCR surgery is typically performed under local anaesthesia with sedation or general anaesthesia, depending on the patient's preference and the surgeon's recommendation.
After Surgery
The method is usually performed as an outpatient procedure, allowing patients to return home the same day. Patients may experience mild discomfort, swelling, or bruising around the eyes and nose, which can be managed with pain relievers and cold compresses. If silicone tubes are placed, they are usually removed after several weeks to months, depending on healing progress. Regular follow-up visits are also scheduled.
Advantages of Endoscopic DCR
Endoscopic DCR offers several advantages over traditional external DCR. It avoids facial scars by accessing the nasal cavity internally, often under local anaesthesia for compliant patients. Direct access minimises tissue damage, preserves facial anatomy, and allows simultaneous management of associated nasal and paranasal conditions contributing to nasolacrimal obstruction. Bilateral procedures can be done concurrently, immediate corrections are feasible during surgery, and failures can be promptly investigated endoscopically. Endoscopic DCR results in reduced operating time, intraoperative bleeding, and postoperative morbidity, often allowing for same-day discharge.
