What is endoscopic dacryocystorhinostomy (DCR)?
Each eyelid has a tiny opening that discharges tears produced naturally by the eyes. Blinking prods tears into these openings. As a result, the tears are unloaded into a small tube and then into a larger area also known as the lacrimal sac. This sac leads to the tear duct, which goes around the bony framework of the nose and discharges into the nasal passage.
One develops the symptoms of tearing when there is a disparity between tear production and drainage function of the lacrimal system. Tearing can consequently be caused by:
- Combinations of both hypersecretion and epiphora
Epiphora is a medical condition which arises either due to excessive tearing as a consequence of too much tear production or because of poor drainage. It emerges as a result of:
- Mechanical obstruction of the lacrimal drainage system connected to trauma, dacryo cystolithiasis, sinusitis and congenital nasolacrimal duct obstruction in children.
- Lacrimal pump failure also known as functional epiphora is usually caused by eyelid laxity, eyelid malposition and punctum eversion.
Dacryocystorhinostomy is an operation which is used to treat this condition of epiphora. The surgery tends to create a new path for tears to drain between one’s nose. It can be carried out externally through an incision in the skin, or endoscopically through the nose without leaving a skin incision.
The process is done to ease the symptoms of a blocked tear duct. These consist of extreme eye watering or crusting around the eye. If the tear duct is infected, one might suffer from:
- Swelling and tenderness around the eye
- Eye irritation
- Mucous discharge
An endoscopic dacryocystorhinostomy surgery aims to eradicate fluid and mucus storage inside the lacrimal sac. This procedure tends to create a direct opening from the lacrimal sac into the nasal passage. It helps to create a direct drainage mechanism which inturn boosts the tear drainage for relief of epiphora.
A telescope is used to look up the nose and locate the site of the obstruction, which is then opened up surgically. This method has the benefit of leaving no scar on the side of the nose.
The assessment and management of an endoscopic dacryocystorhinostomy procedure may include both an ophthalmologist and an otolaryngologist.
What are the benefits of an endoscopic dacryocystorhinostomy surgery?
The benefits of undergoing an endoscopic dacryocystorhinostomy surgery can be summarized as:
- Minimal pain which can be controlled using medications
- Rate of infection is low after surgery
- No facial scarring
What are the symptoms of epiphora?
The symptoms of epiphora are:
- Discharge from the eye
- Pain in the ear duct or the surrounding area
- Enlarged visible blood vessels
- Sharp pain
- Eyelid swelling
- Blurred vision
- Light sensitivity
What are the causes of epiphora?
The tear duct may face blockage due to several distinct reasons such as trauma, previous surgery, tumor, or an inflammatory medical condition. Most of the time it is difficult to decipher the underlying causes.
- Anatomical issues one was born with
- Chronic nasal and sinus swelling
- Blockage from a tumor
- Foreign objects and injury
- Infection and inflammation
- Tear duct obstruction
- Eyelid changes
- Dry eyes
- Cold and flu
- Over use of digital devices
- Sun and wind
- Injury to the face
- Injury to the nose
- Topical blood pressure drugs
- Chemotherapy drugs
- Eye drops
Diagnosis, Pre surgery and Post surgery precautions
To get a better understanding of one’s condition prior to the procedure of endoscopic dacryocystorhinostomy, an ENT specialist will administer tests like:
- CT scan of the nasal passages
- MRI scan of the nasal passages
What are the risk factors related to an endoscopic dacryocystorhinostomy surgery?
The risk factors related to an endoscopic dacryocystorhinostomy surgery are mentioned below as:
- Oddly merged tissue in the nose
- Dislocation of the stent placed in the duct
- Excess bleeding
- Orbital hematoma