Dacryocystorhinostomy DCR in Bangalore

When Is A Dacryocystorhinostomy Recommended?

As discussed, dacryocystorhinostomy is required when a blockage has formed in the nasolacrimal duct, impairing the drainage of tears from the eyes into the nose. Here are some of the conditions where a dacryocystorhinostomy is recommended.

• Chronic Epiphora: It involves persistent tear flow (tearing) and overflow of tears. This is a primary indication for DCR as it can interfere with vision and daily activities, and cause discomfort and social embarrassment.
• Recurrent eye infections: When the tear flow becomes stagnant, it can create a breeding ground for bacteria. This can further cause frequent conjunctivitis or infection of the lacrimal sac.
• Mucocele formation: Due to mucus buildup in the lacrimal sac, a cyst-like lesion called mucocele may form. It can cause pain and swelling, and also increase the risk of infection.
• Acute dacryocystitis: The blockage of the nasolacrimal duct can further cause acute infection, leading to pain, swelling, and redness near the nose.
• Failed conservative treatments: If less invasive treatment options like antibiotics, balloon dacryoplasty, and tear duct probing fail to resolve the symptoms or the blockage, surgery might be the only remaining option.
• Functional lacrimal duct obstruction: Sometimes, there might not be such a blockage, but the tear drainage system may not function effectively. If poor tear drainage and similar symptoms are found, again a DCR procedure might be needed.

DCR is considered to improve the individual’s quality of life, alleviate the symptoms, and reduce the risk of further infections and complications.

How Does An Endoscopic Dacryocystorhinostomy Work?

Here’s what happens before, during, and after a dacryocystorhinostomy (DCR) procedure:

Before Surgery

Being well-prepared for any surgery is crucial to its success and smooth recovery. The same is true for DCR. Here’s an overview of how one can prepare in advance for an endoscopic dacryocystorhinostomy (DCR):

• Medical evaluation: An ENT surgeon or an ophthalmologist evaluates and examines the tear duct blockage and your eyes’ health.
• Medical tests: Tests like CT scans and dacryocystography might be done to view the nasolacrimal duct and its surrounding structures.
• Medications: Your medications and supplements, if any, are adjusted to prevent any negative impact on the surgery. You may be told to stop certain medications or lower the dose. Antibiotic eye drops may also be prescribed to be used before surgery to minimize infection risk.
• Fasting: As with any surgery, you will be advised to fast for a period before surgery in order to avoid any complications with anesthesia.
• The day of surgery: You should pre-plan for someone to drive you back home after the procedure. Also, You should come in loose, comfortable clothing, and avoid any makeup, hair accessories, and jewelry. You will also be asked to remove your contact lenses if worn.
• Mental preparation: Make sure that you are mentally prepared for the procedure. Clear all your doubts before the procedure and prepare well to be ready for the procedure both mentally and physically.

Carefully following all given instructions and openly communicating with the healthcare provider will contribute to the success of the procedure.

During Surgery

The endoscopic dacryocystorhinostomy (DCR) can be described step-by-step as mentioned below:

• Anesthesia administration: Either general anesthesia or local anesthesia with sedation is used in order to make the procedure painfree.
• Nasal preparation: The surgeon applies a decongestant and local anesthesia to the nasal mucosa to reduce
• Nasal endoscopy: An endoscope (a thin tube with an attached camera) is inserted into the nostril to examine the lacrimal sac.
• The surgeon makes a small incision in the nasal mucosa to access the lacrimal sac. The lacrimal sac is opened carefully and any tissue or debris obstructing the path for the tears are removed.
• Placement of Stents or Tubes (Optional): In some cases, silicone tubes or stents may be placed in the lacrimal system to maintain the newly created opening and facilitate drainage. These tubes are typically left in place for several months before being removed in a minor procedure.
• Closure: The nasal mucosal flap is repositioned and closed with the help of sutures. Patients may require nasal packing in order to minimise bleeding and swelling.

The patient is now moved to a recovery room, where his/her vitals are monitored. S/he is instructed on post-operative care before being discharged.

After Surgery

Here’s what typically happens after an endoscopic dacryocystorhinostomy (DCR) Surgery:

• Managing pain: It is normal to experience some discomfort and nasal congestion after the DCR surgery. It is managed with prescribed pain relievers.
• Nasal care: The nasal passages are to be kept clean. This can be done by using saline sprays that moisten the nasal lining.
• Medications: Antibiotic and/or steroid nasal sprays/drops may also be prescribed for the prevention of infections and inflammation.
• Activity restrictions: Strenuous activities like heavy lifting are to be avoided for a week. This minimizes the risk of bleeding and damage to the surgical site.
• Avoid blowing the nose: Another important point to note is that the patient should avoid blowing the nose for a period of time post-DCR to prevent disrupting the new drainage pathway. Make sure to sneeze with your mouth open to transfer the pressure from the nasal passages toward the mouth.   
• Post-operative visits: All the scheduled follow-up visits should be attended as they are crucial to evaluate the healing process and remove any nasal packaging and stents if placed.

The recovery phase is also about monitoring for any complications. Early detection of signs of complications leads to quick solutions. You’re supposed to contact your doctor immediately if you find any such signs. Also, maintaining patience and adhering to post-operative care encourage maximum improvement.

Recovery time varies from person to person, ranging from a few days to weeks or months. The endoscopic dacryocystorhinostomy (DCR) surgery can significantly reduce your symptoms like tearing and recurrent infections, and create a lasting solution for tear drainage issues.

Benefits And Risks Of Dacryocystorhinostomy

Benefits And Risks Of Dacryocystorhinostomy

The endoscopic approach for dacryocystorhinostomy (DCR) surgery offers several benefits over the traditional method but also comes with its own inherent risks. Here’s a brief of the same:

Risks:

• Risks of bleeding and infection
• Anesthesia-related complications like nausea and vomiting
• Closing of the newly created tear duct during healing, leading to the need for an additional surgery
• Injury to the surrounding structures in the sinuses or the nose
• Puncture of the bone separating the nasal cavity from the brain, leading to cerebrospinal fluid leak and requiring immediate medical attention
• Recurrence of symptoms even after the surgery

Benefits:

• It is minimally invasive procedure,
• Does not require external incisions
• Less pain and discomfort after the procedure
• Shorter recovery time
• High success rate in restoration of tear drainage and alleviation of symptoms
• Better quality of life

It is essential to weigh both the risks and benefits of surgery before undergoing one to make informed decisions, minimize complications, and maximize the chances of the success of the surgery.