DCR and DCT Surgery (Tear Duct Surgery)

DCR can be performed by two main approaches, each with its own advantages:

• External DCR: The traditional approach. A small incision (approximately 10–15 mm) is made in the skin on the side of the nose, close to the inner corner of the eye. A window is created in the lacrimal bone, and the lacrimal sac is opened and sutured to the nasal mucosa, creating the new drainage opening. A silicone stent is placed through the drainage system and removed 1 month later at a follow-up appointment and is generally not felt or noticed by the patient. The skin incision heals to a very fine scar that is usually barely visible.
• Endoscopic (Endonasal) DCR: Performed entirely through the nose using a nasal endoscope, leaving no external scar on the skin. The nasal mucosa and lacrimal bone are opened from inside, creating the same bypass opening. This approach is preferred for cosmetically sensitive patients. Success rates are slightly lower than external DCR.
• DCT (Dacryocystectomy): The lacrimal sac is excised through an external approach. Used when sac reconstruction is not possible or indicated.

You may be a good candidate for DCR surgery if:

• You have confirmed nasolacrimal duct obstruction causing persistent watering of the eye (epiphora) that is not resolving with conservative management.
• You have experienced one or more episodes of dacryocystitis (tear sac infection) secondary to blocked tear drainage.
• You have a chronic mucocele (distended, mucus-filled lacrimal sac).
• You are in reasonable general health and are able to undergo surgery under local anaesthesia, sedation or general anaesthesia.
• For DCT specifically: when a lacrimal sac tumour or other pathology makes sac preservation inappropriate.

A full assessment including syringing and probing of the lacrimal drainage system and, where indicated, imaging (CT-Dacryocystogram) is performed before surgery to confirm the level and nature of the obstruction.

Pre-surgery

A detailed oculoplastic consultation including assessment of the tear drainage system. Syringing of the lacrimal passages confirms the obstruction. Blood thinning medications are stopped as directed. Pre-operative photography is taken. Any acute infection (dacryocystitis) must be treated with antibiotics before elective DCR is performed.

On the day of surgery

Surgery is performed under local anaesthesia with sedation or general anaesthesia and usually takes 45–90 minutes. A silicone stent is placed at the end of the procedure. You go home the same day.

Post-operative period

Mild nasal bleeding, swelling, and bruising around the nose and inner eye area are expected in the first few days. Nasal decongestant drops and antibiotic eye drops are prescribed. The silicone stent is removed in the clinic 1 month after surgery as part of routine follow-up.

Available Options:

• Local Anaesthesia with Sedation: The most common choice for DCR. The surgical area is numbed with local injections and intravenous sedation provides relaxation and comfort. Most patients are not aware of details of the procedure.
• General Anaesthesia: Used when patient preference, anxiety, or the complexity of the procedure warrants complete unconsciousness throughout.

Factors Influencing Choice:

• Patient preference and anxiety level
• Overall medical fitness
• Whether additional procedures are being performed at the same time

First 24–48 Hours

Some nasal bleeding (like a nosebleed) is expected immediately after surgery; this settles quickly. Avoid blowing the nose. Apply cold compresses to the area to reduce swelling. Sleep with the head elevated.

First Week

Bruising and swelling around the nose and inner eyelid gradually resolve. Antibiotic eye drops and nasal saline rinses are used as prescribed. Most patients feel comfortable returning to light work and daily activities within 5–7 days. Avoid strenuous exercise for 2 weeks.

Weeks 2–6

The external scar (for external DCR) fades progressively over 3–6 months and is usually barely visible. The silicone stent remains in place and is generally unnoticeable. Watering of the eye often improves shortly after surgery as the new opening begins to function.

Stent Removal (1 Month)

The silicone tube is removed at a clinic appointment — a simple, painless procedure. Final assessment of the outcome is made at this visit and at a follow-up appointment one month later.

• Resolution of watering eye: DCR restores normal tear drainage, eliminating chronic epiphora in the majority of patients. Success rates for external DCR are approximately 90–95%.
• Prevention of recurrent infections: By restoring drainage, the stagnant pool of tears and mucus that fosters bacterial growth is eliminated, preventing recurrent dacryocystitis.
• Reduction in eye discharge: Mucoid or purulent discharge caused by the infected or obstructed sac resolves after surgery.

• Failure or closure of the new opening, requiring revision surgery (in approximately 3–5% of cases).
• Nasal bleeding in the first 24–48 hours — usually minor and self-limiting.
• Infection, which is uncommon with appropriate antibiotic prophylaxis.
• Visible scar from the external approach, which typically fades to a fine line within 6 months.
• Premature loss of the silicone stent before planned removal.