Dacryocystorhinostomy (DCR)

Dacryocystitis is an infection in the tear ducts of the eye or in the tear sac, called the lacrimal sac. Tears are made by a small organ above your eye, under the upper lid. At the inner corner of each upper and lower eyelid is an opening to a small tube or tear duct. Tear ducts carry away tears that have rinsed the front surface of the eye; this allows fresh tears to come in. The lacrimal sac is connected by a tube to each tear duct, and to the inside of your nose.

A tear duct can get infected if it becomes blocked and bacteria collect in the ducts or the lacrimal sac. A blockage near the nose also can cause excessive tearing from the eye.

Although tear duct infections can occur at any age, they are most common in infants, who commonly have a congenital (inborn) obstruction of the nasolacrimal duct. Infants with this problem have a narrower drainage passageway that will widen with time as they grow. Most children with the disorder outgrow it by the time they are 1 year old. If adults get a tear duct infection, it usually is because their tear ducts have become abnormally narrowed by continued growth of surrounding bone. The ducts are more rigid and less able to flush out the debris that can cause blockages.

Tear ducts also can become blocked after trauma to the nose or eyes, such as a broken nose, or by nasal polyps.

When a tear duct infection first occurs, it is called acute dacryocystitis. If a tear duct infection is not treated quickly or if it causes minor symptoms that build up over a long period, it can be more difficult to cure. The infection is then called chronic dacryocystitis.

Symptoms

Typical symptoms of acute tear duct infection include:

  • Pain, redness and swelling of the lower eyelid at the inner corner of the eye
  • Excessive tearing
  • Pus or discharge from the eye
  • Fever

Symptoms of chronic (long-lasting) tear duct blockage are less severe. Although there may be tearing and perhaps some pus or discharge, usually there is little or no pain, redness or swelling.

Dacryocystorhinostomy (DCR) surgery is a procedure that aims to eliminate fluid and mucus retention within the lacrimal sac, and to increase tear drainage for relief of epiphora (water running down the face). A DCR procedure involves removal of bone adjacent to the nasolacrimal sac and incorporating the lacrimal sac with the lateral nasal mucosa in order to bypass the nasolacrimal duct obstruction. This allows tears to drain directly into the nasal cavity from the canaliculi via a new low-resistance pathway. Nasolacrimal duct obstruction (NLDO) can result in a watery eye, due to obstruction of the outflow of tearsNasolacrimal duct obstruction, occurs as a congenital or acquired disease.
Symptoms

  • Tearing (Epiphora)
  • Mucopurulent discharge
  • Mattering of lashes and lids, crusting in the morning
  • Pain
  • Blurred vision from tears
  • Bloody tears
  • Dacryocystitis (abscess infection of the lacrimal sac in the inner corner of eye area)

Prognosis
Prognosis after DCR is excellent, with success rates up to 90-95% for the external approach. Although there has been a wider range of success rates reported with the endonasal DCR technique, some studies have demonstrated success rates comparable to those obtained with external DCR.