Dacryocystorhinostomy

Surgical procedure to treat nasolacrimal duct obstruction

Dacryocystorhinostomy

Dacryocystorhinostomy (DCR) is a surgical procedure that aims to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct is blocked. This procedure is commonly performed to treat epiphora, which is the overflow of tears onto the face, and chronic dacryocystitis, an infection of the lacrimal sac.

Anatomy of the Lacrimal System

The lacrimal apparatus consists of the lacrimal glands, which produce tears, and the lacrimal drainage system, which includes the puncta, canaliculi, lacrimal sac, and nasolacrimal duct. Tears are produced by the lacrimal glands and spread across the eye surface. They drain through the puncta into the canaliculi, then into the lacrimal sac, and finally through the nasolacrimal duct into the nasal cavity.

Indications for Dacryocystorhinostomy

DCR is indicated in cases of nasolacrimal duct obstruction that lead to symptoms such as excessive tearing, recurrent eye infections, or chronic dacryocystitis. The obstruction can be due to congenital anomalies, trauma, inflammation, or tumors.

Surgical Technique

Dacryocystorhinostomy can be performed using an external or endoscopic approach. The external approach involves a skin incision near the bridge of the nose, while the endoscopic approach is performed through the nasal cavity using specialized instruments.

External Dacryocystorhinostomy

In the external approach, a small incision is made on the side of the nose to access the lacrimal sac. The surgeon creates a new passage between the lacrimal sac and the nasal cavity, bypassing the blocked nasolacrimal duct. The incision is then closed with sutures.

Endoscopic Dacryocystorhinostomy

The endoscopic approach involves the use of a nasal endoscope to visualize the nasal cavity and lacrimal sac. A similar passage is created between the lacrimal sac and the nasal cavity without an external incision. This approach is less invasive and may result in quicker recovery times.

Postoperative Care

After DCR surgery, patients may experience mild discomfort, swelling, and bruising around the surgical site. Antibiotic eye drops and nasal decongestants may be prescribed to prevent infection and reduce inflammation. Follow-up visits are necessary to ensure proper healing and patency of the new tear drainage pathway.

Complications

Potential complications of DCR include bleeding, infection, scarring, and failure of the new passage to remain open. In some cases, additional surgery may be required to address these issues.

Related pages

• Epiphora
• Dacryocystitis
• Lacrimal apparatus
• Nasolacrimal duct

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  Dacryocystorhinostomy