Dacrocystorhinostomy (DCR)

Introduction

A Dacrocystorhinostomy (DCR) is a procedure performed to bypass the tear ducts within the nose to improve the clearance of tears from the eye. It can be done externally via an incision on the side of the nose or via an endoscopic approach using the nostril for access and thus avoiding external cuts.

Indications

The main indication is epiphora or watery eyes. In some cases, it can be performed for recurrent or chronic infection of the tear duct (Dacrocystitis).

Risks

DCR carries the same general risks as all operations including:

  • Pain.
  • Bleeding.
  • Infection.
  • Scarring.
  • Failure to resolve symptoms.

Specific risks of sinus surgery include;

  • Significant bleeding.
  • Loss of taste and smell.
  • Eye injury.
  • Cerebrospinal fluid leak.

Dr Morrissey can discuss these risks and other matters specific to you and your condition should you wish to make an appointment.

Treatment Alternatives

There may be alternatives to surgery suitable for some people. This is particularly the case where there are multiple contributing issues leading to epiphora.

Dr Morrissey and / or your Ophthalmologist can help you determine the best course of action for you.

Preoperative Instructions

DCR is performed under a general anaesthetic. You will need to fast prior to surgery and should follow the provided instructions. If you have any queries or concerns please contact your Anaesthetist, admitting hospital or Dr Morrissey.

Procedure

Once you are asleep, Dr Morrissey will use a high definition camera to identify the site of the tear duct within the nose. In some instances, a deviated septum will need to be corrected to allow access. The bone overlying the duct is then removed and the duct opened directly into the nose. This creates a much wider opening than the natural one. Once open, Dr Morrissey sometimes places a stent to hold the tear duct open. This is removed at a later date in the consulting rooms.

Once complete, Dr Morrissey will ensure bleeding is controlled and the nose is clean prior to finishing.

Postoperative Instructions

General

During the first 1-2 weeks after surgery you may feel quite tired and run down. Your nose may feel congested as if you have a cold or flu. To maximise recovery;

  • Avoid bending, lifting, or vigorous activity for 2 weeks.
  • No work, exercise or sport for 14 days - you may do some gentle walking.
  • Avoid hot showers and baths as they can promote nose bleeding.
  • You may gently blow your nose after the surgery. If you need to sneeze, do so through an open mouth (and cover it).

Posture

Try to keep your head up as much as possible. Keep your head elevated when resting, and sleep with 2 pillows if possible. Avoid stooping over.

Bleeding

It is normal to have nasal ooze for the first 24 hours, which will reduce by about half each day. Minor bleeding is expected for 3-4 days.

Major bleeding is rare but can occur and is typically quite profuse. If this happens present to the nearest hospital emergency department or call an Ambulance.

Diet

There are no dietary restrictions and you may eat as soon as food is tolerated. A cool diet in the first few days helps minimise bleeding.

Eye Care

The eye may continue to water after surgery for a few weeks. This is due to swelling in the region. It should improve with time.

Eye drops may be used in some cases. Please follow the instructions provided with the prescription.

There are often small tubes at the inner aspect of the eye. These act to keep the tear pathway open and reduce scarring. Dr Morrissey often leaves these in place while the site is healing. He will discuss their removal with you at your post-operative appointment.

Fever

It is common to have a mild fever for the first 24 hours after the operation.  Please call Dr Morrissey’s rooms or see your GP if there is a persistent fever greater than 38.5°C.

Pain

The maximum discomfort will occur in the first couple of days to a week after surgery. You may experience some headaches. Take the pain medication as prescribed. Patients often describe their discomfort as similar to a head cold.

Appearance

Minor bruising and swelling is to be expected around the eyes and face, which may be more apparent in the mornings.

Medications

  • Saline nasal rinse (Flo or Sinus rinse): please rinse your nose with the bottle prescribed (over a sink) 4 times a day.  Continue until reviewed by Dr Morrissey. Refill sachets (x50 or x100) can be purchased from your local pharmacy.
  • Paracetemol (Panadol): Please take regularly as per manufacturer’s instructions to minimize pain after surgery.
  • Extra Pain Medication (Tramadol / Oxycodone): These should be taken as prescribed if you need them.
  • Eye Drops: In some cases, these may be used after surgery. Please use as prescribed.
  • Antibiotics: please take as directed.

Avoid Aspirin and Nurofen as they increase the risk of bleeding.

When to call the Doctor

  • If you have any extreme swelling or bruising that is not settling.
  • If you have persistent pain not relieved by the medication.
  • Elevated temperature over 38.5°C.
  • Bleeding that has not subsided after 20 minutes of applying gentle pressure to the side of the nose while sitting in an upright position with head bent forward (Oozing can be expected).

Follow Up Appointment

At the time you book your surgery a post-operative appointment will usually be organised. Please contact Dr Morrissey’s office if you are unsure as to the appointment details.

How to contact Dr Morrissey

For non-emergency issues please call (07) 4646 4275. for further instructions.

Dr Morrissey shares ‘on-call’ arrangements with other ENT surgeons and one is usually available to answer questions. After hours the “on call” ENT surgeon can be contacted via the Toowoomba Base Hospital on (07) 4616 6000.

Should your concerns not be addressed via a phone call, please present to your nearest Emergency Department.

In the event of an Emergency call 000 or attend the nearest Emergency Department.

Related Information

Watery Eyes