Introduction
A dacrocystorhinostomy (DCR) is a procedure which is used to bypass a blocked tear duct (Nasolacrimal duct). The main symptom of having a blocked nasolacrimal duct is overflow of tears. The procedure is done through the nose and has a success rate of reducing the tearing which is over 95%. Dr Robinson has co-authored a book chapter with Dr Raymond Sacks on DCR and nasolacrimal duct obstruction. Dr Robinson is actively involved in teaching training ENT surgeons how to perform DCR when he works at the Gold Coast University Hospital.
Indications
Dr Robinson performs endoscopic DCR when patients have tearing which is caused by a blocked nasolacrimal duct. There are other causes of tearing aside from a blocked nasolacrimal duct including:
- Irritation of the eye causing excess production of tears
- Lower lid instability / laxity causing tears to not flow in the correct direction
Dr Robinson will assess what the cause of the excess tearing is – if it is caused by a blocked nasolacrimal duct, then he may recommend an endoscopic DCR. This procedure is sometimes also done in conjunction with a septoplasty (straighten the cartilage in the middle of the nose) to allow for access to the site when the nasolacrimal duct is located and blocked.
Procedure
Having a DCR involves a general anaesthetic. The procedure takes approximately one hour. There are no incisions on your skin when you have a DCR – the whole operation is performed by operating through your nostril. The general steps in the procedure include:
- Sepoplasty if required to access the area of the nasolacrimal duct
- Identification of the nasolacrimal duct
- Removal of bone over the front and back of the duct
- Opening of the blocked duct into the nose
- Placement of stents in the duct which stay in place for up to 6 weeks
Following the DCR you may have a slight amount of fullness on your cheek which resolves. There are stents in your nasolacrimal duct which are small tubes sitting in the opening of the duct which keep the duct open during the healing process.
Dr Robinson usually removes the stents between 6 – 12 weeks post operatively depending on the findings during the operation.
Postoperative Instructions
After the procedure, Dr Robinson will usually get you to use a saline wash in your nose for approximately 6 weeks to wash any scabs or crusts out of your nose.
Occasionally Dr Robinson will prescribe some drops for the eye to facilitate improved healing post operatively. Most people who have a DCR performed are able to return to work within a day.
Combined DCR Clinic
Dr Robinson runs a combined DCR clinic with Dr Sharon Morris who is an Opthalmologist. Dr Morris has had sub specialist training in ocular plastic surgery and both she and Dr Robinson compare tough cases and work together on the more complex DCR cases. The combined DCR clinic facilitates improved patient care and outcomes for patients with complex nasolacrimal duct obstruction.
