DCR - Dacryocystorhinostomy
The normal flow of tears is from the gland on the outer upper corner of your eye to the inner corner, through to your nose and into your throat. If there is a blockage in the passage from the eye to the nose, a watery or infected eye may result.
THE PUNCTUM is the tiny opening at the inner corner of your upper and lower lids. This is the beginning of the drainage passage.
THE CANALICULI are fine horizontal passages that connect both the punctum with the tear sac.
THE TEAR SAC rests at the side of your nose. The sac collects tears and mucous before they pass into the nose.
The sac drains into the nose via the NASOLACRIMAL DUCT. This duct ends deep inside the nose. Normal tearing drains into the nose and down the throat. That is why crying may cause your nose to run.
INDICATIONS FOR SURGERY
Not all blocked tear ducts need surgery. People with dry eyes may be unaware that they have a blocked tear duct. Surgery is indicated when tearing is bothersome or when infection occurs.
DCR (dacryocystorhinostomy) by-passes the blockages in the nasolacrimal duct. The tear sac is directly connected to the nasal cavity. The surgery takes about 25 minutes per side. A general anaesthetic or a local anaesthetic with intravenous (IV) sedation can be administered. Local anesthetic with IV sedation has significant advantages, including less bleeding and quicker recovery times. With the IV sedation you will be aware of things happening but will be comfortable. You may not remember the surgery very well afterwards. With a general anesthetic you will be unconscious throughout the procedure. General anesthesia does carry some higher risks and slower recovery time.
The success rate with DCR surgery is about 95%. As with any kind of surgery, there are RISKS associated with this procedure.
- Failure of the surgery due to scar tissue forming in the nose. A temporary tube will be placed in the nose to prevent scarring in any patients with risk factors for failure. In the event of surgical failure, it is possible to re-operate through the nose and remove scar tissue. When the scar tissue involves the canaliculi or is recurrent, a permanent by-pass tube (Jones Tube) may be used to drain the tears.
- There is a risk of post-operative hemorrhage, excessive bruising, and excessive swelling. It is very important to avoid blood thinners and to have normal blood pressure to prevent bleeding. You will receive a list of foods and medications to avoid prior to your surgery. All patients are asked to remain in Calgary for the night following their surgery.
- All skin incisions result in scarring that may take 6-12 months to fade (scarring will never disappear totally).
- Following successful surgery you may notice air vent from the punctum with forceful nose blowing. This is considered normal.
* * * Smoking causes poor healing and should be avoided. * * *
Temporary Tubing may be used to keep the new drainage passage open after surgery. The decision to use temporary tubing depends on risk factors for scar formation. Temporary tubes help hold the new passage open. This temporary tubing is removed three weeks to six months after the surgery. This is easily done, like removing a stitch. Tears may not drain properly until this temporary tubing has been removed.
Permanent tubes (“Jones Tubes”), are tiny glass tubes that can be left in place indefinitely. Jones tubes can be removed or exchanged if needed. Keep the Jones Tube clear by rinsing with saline every morning. To do this, put a drop of artificial tears into your eye, hold your nose closed and gently sniff in.
- You should not drive to or from your surgery. Bring a friend or relative to drive you, or take a taxi.
- Discontinue all blood thinners and ASPIRIN products one week prior to surgery (including Coumadin, Heparin, Advil, Motrin, Naprosyn, Ginko Baloba, and Green Tea).
- DO continue taking all of your regular medications, especially blood pressure medications.
- Please do not wear any eye make-up the day of your surgery.
- A blood test MUST be done 1 – 2 weeks prior to the surgery date.
- Do NOT resume blood thinners for 1 week after surgery.
- Apply ice (or frozen peas) to your nose and neck. This helps slow the flow of blood to help reduce bruising and swelling.
- Gentle pressure, with a cold compress, will also help to reduce the amount of bruising and swelling. You can switch to warm compresses or no compresses, after a few days.
- Elevate the head (for nighttime sleeping) with an extra pillow or sleep in an easy chair.
- Avoid blowing your nose and sneezing. If you do sneeze, have your mouth open.
- Avoid doing anything that causes blood to rush to your head for at least one week. (E.g. lifting anything heavy, leaning over the sink to wash your hair, bending to pick up something).
- You can gently clean crusting from your nose with saline rinse. Combine 1tbsp salt and 1 tbsp baking soda in a basin of warm water. (Rhinaris can be used instead of salt and baking soda). Hold the solution in cupped hands, then gently sniff into your nose. Let your nose drain on its own. This needs to be done carefully as it may cause a small nosebleed.
- Apply Vaseline or Polysporin to the scar three times a day.
- If you wear glasses, try to place the nose pads below the suture site.
- A vaporizer at your bedside, Chap Stick and drinking lots of water will help the dryness in your mouth and nose.
- The patch may be removed the next day or at bedtime.
- You can use Dermatix on the scar site once the stitches have dissolved or been removed.
- Resume your diet as tolerated.
- Most patients require 1 – 2 weeks recovery time.
- If you are taking antibiotics prior to surgery, you will continue as per your instructions.
- Use medications as prescribed by our office, for post-operative care.
We do not recommend travel outside the city for the first 24 hours after surgery due the risks of nose bleed. If you live out of Calgary we can arrange a bed for you overnight in the hospital or you may stay with friends, relatives, or at a hotel.
WHAT IS NORMAL AFTER SURGERY?
- Some bleeding is normal for 24 to 48 hours. This may be a steady trickle but there should not be gushing of blood.
- It is normal to have fluid collect at the lower lids where the lid and cheekbone meet. This looks like a fluid blister and will go away on its own. It will look like you have a “shiner”.
- Bruising, redness and swelling often last two weeks or more and are a normal reaction to the sutures.
- Tearing may be normal for the first few weeks.
- The side of your nose will be swollen. The stitches at the side of your nose are dissolving.
- You may be able to blow air through your new passage, this is sometimes noticeable when you sneeze or blow your nose.
WHAT IS NOT NORMAL AFTER SURGERY?
- Uncontrolled swelling, pain, and loss of vision is a medical emergency (Extremely rare). If this happens contact the office immediately or go to an emergency room.
A minor nosebleed is common. A nosebleed that can't be stopped occurs rarely. High blood pressure can make nose bleeds difficult to stop. If you should experience excessive bleeding, apply pressure on the wound with ice packs. Lie quietly with your head elevated. If you cannot stop the nosebleed you must go to an emergency department. Do not go to a walk-in clinic. Do not come to our office. Tell the emergency room staff to please call Dr. Ashenhurst at home if there are problems.
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