Dacryocystorhinostomy (DCR) is a

surgical procedure Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

to restore the flow of tears into the nose from the

lacrimal sac The lacrimal sac or lachrymal sac is the upper dilated end of the nasolacrimal duct, and is lodged in a deep groove formed by the lacrimal bone and frontal process of the maxilla. It connects the lacrimal canaliculi, which drain tears from the ey ...

when the

nasolacrimal duct The nasolacrimal duct (also called the tear duct) carries tears from the lacrimal sac of the eye into the nasal cavity. The duct begins in the eye socket between the maxillary and lacrimal bones, from where it passes downwards and backwards. The ...

does not function.

Process

Traditional

A small incision is made on the side of the nose and some bone is removed to make a connection to the nose. Drains are left behind to prevent the gap from becoming closed and are removed after a few months. A Jones or Crawford tube is placed to facilitate the flow of tears from the eye to the nose. The lacrimal sacs must be avoided during this surgical procedure.

Endoscopic

The operation can also be performed endoscopically through the nose where an opening is fashioned in the lacrimal sac from within the nose. The advantages include lesser peri-operative morbidity, and no scar. Data suggests a slightly lower success rate than the "traditional" technique. With the advent of nasal endoscopes, endoscopic dacryocystorhinostomy is becoming popular. In this procedure, a nasal endoscope is used to visualise the lacrimal sac through the nasal cavity. The bone covering the lacrimal sac is nibbled out. The medial wall of the sac is incised or excised, facilitating drainage of tears into the nasal cavity. This procedure avoids scarring.

Adjunctive use of antimetabolites

Antimetabolites have been used with intent to increase the success rates of dacryocystorhinostomy. At a follow-up time of more than six months, antimetabolites may improve functional and anatomic results. The use of antimetabolites had only minor

side effects In medicine, a side effect is an effect, whether therapeutic or adverse, that is secondary to the one intended; although the term is predominantly employed to describe adverse effects, it can also apply to beneficial, but unintended, consequence ...

Contraindications

Atrophic rhinitis is an absolute contraindication. In case of acute dacryocystitis, this operation can not be done immediately, rather it is done after a period of time. In case of elderly patients (above 70 years of age), dacryocystectomy is preferred to dacryocystorhinostomy as old age naturally causes atrophy in nasal mucosa.

References

External links

eMedicine: Dacryocystorhinostomy

Dacryocystorhinostomy - EyeWiki
{{Eye surgery Oculoplastic surgery