ENDOSCOPIC DACROCYSTORHINOSTOMY (DCR)

Endoscopic DCR surgery is a surgical procedure performed to treat abnormal tearing due to narrowed or blocked tear drainage tubes, also known as nasolacrimal duct obstruction. In children, blockage of this duct can result from a membrane's failure at the end of the tear duct (Valve of Hasner), to open normally at or near the time of birth. In adults, this can result from inflammatory medical conditions such as trauma or a tumour. However, it most commonly occurs without an identifiable cause.

Tear duct obstruction can be diagnosed by looking at the patient's history of tearing and discharge at a very early age. One of the major factors in determining endoscopic DCR surgery's success rate is the level of obstruction in the lacrimal drainage system.

The nasolacrimal duct is a small tube that connects the eyelids to the inner nose and is responsible for acting like an inner drainage tube or "gutter" for tears. One's eyes need lubrication - the function of tears. This lubrication needs to be regularly changed, so tears are continually produced, and the excess goes down the nasolacrimal duct into the nose.

Procedure

This duct can get blocked, resulting in tears welling out of the eye down the cheek, especially with cold weather. The problem is normally observed by the eye specialist (Ophthalmologist) first, who will ensure that the concern is not related to any other eye-related condition. Traditionally they would perform a DCR operation to repair the nasolacrimal duct's obstruction externally through an incision on the cheek, between the eye and nose.

Today DCR operation is usually performed by an ENT (ear, nose and throat) surgeon who is trained to do the whole operation through the nose, thus avoiding the need to make any cuts on the face. The endoscopic DCR operation is done under general anaesthesia, as a day-care case (in and out the same day), and takes about 45 minutes. A fine telescope that has a camera and a light, called an endoscope, will be passed through the nose to the affected area. A DCR procedure's objective is to bypass the obstructed nasolacrimal duct and allow for tear drainage into the nose directly from the lacrimal sac.

Recovery

A little tube is normally inserted as a stent in the nasolacrimal duct, which is left in place for approximately 6 weeks before being removed painlessly in the ENT surgeon's rooms.

The endoscopic approach ensures that pain is minimal and can be controlled with mild prescription pain medication. Infection is uncommon, but many ENT surgeons prefer to administer antibiotics. There is no bruising or external evidence that endoscopic DCR surgery has been performed. The endoscopic DCR technique is a safe, effective, low complication technique that yields good aesthetical-functional results and shows a success rate similar to that of external approach when performed by experienced ENT surgeons. Other advantages include:

• It allows a one-stage procedure to also correct associated nasal pathology that may be causative.
• It is less bloody and messy than the external approach.
• The success rate is comparable to the external approach.
• It provides a better aesthetic result with no external scar.
• It preserves the pumping mechanism of the orbicularis oculi muscle.