Tear Duct Obstruction and DCR Surgery
Watering eye · Dacryocystitis · Dacryocystorhinostomy · Prof. Dr. Fırat Helvacıoğlu, FEBOS-CR · Veni Vidi Eye Clinic, Caddebostan – Kadıköy, Istanbul
Tear duct obstruction prevents tears from draining into the nose. As a result, tears overflow onto the cheek (watering), leading to infection of the lacrimal sac. In infants, most obstructions open on their own; if not, the doctor performs probing. In adults, the permanent solution is DCR (dacryocystorhinostomy). This surgery creates a new passage between the lacrimal sac and the nose, with a success rate of about 90%.
What is tear duct obstruction?
Tear duct obstruction is the narrowing or blockage of the nasolacrimal duct. This passage drains tears from the inner corner of the eye into the nose. Tears overflow onto the cheek (epiphora). Fluid collecting in the sac can become infected, causing a painful swelling at the inner corner and purulent discharge (dacryocystitis).
Tear duct obstruction and DCR surgery
Shows the tear drainage pathway, the obstruction and the new passage created by dacryocystorhinostomy (DCR).
- The tear drainage pathwayTears drain from the small canals at the inner corner of the eye into the lacrimal sac. From there they pass through the duct into the nose.
- ObstructionA blockage in the duct makes tears overflow onto the cheek (watering); fluid collecting in the sac can become infected and cause swelling and discharge.
- DCR surgeryThe surgeon creates a new opening in the thin bone between the sac and the nose and may place a temporary fine silicone tube.
- ResultTears bypass the blocked duct and drain directly into the nose; we remove the silicone tube a few months later.
Causes of tear duct obstruction in infants and adults
- Congenital obstruction: In infants, it occurs when the membrane at the end of the duct fails to open into the nose. Most open on their own. In a study of infants aged 6–10 months, the obstruction resolved without surgery in 66% of eyes within 6 months. These infants received massage and, when needed, antibiotics. If it does not open, the doctor performs probing.
- Acquired obstruction in adults: Age-related narrowing is the most common cause and occurs more often in women. Chronic sinusitis, nasal injuries, nasal surgery and certain medications can also be responsible.
Tear duct obstruction does not cause every watering eye: dry eye, blepharitis, eyelid malposition and allergies can also cause watering. The doctor checks at examination whether the duct is open with a syringing (lavage) test.
DCR (dacryocystorhinostomy) surgery
DCR is an operation that creates a new passage between the lacrimal sac and the nasal cavity. It allows tears to bypass the blocked duct and drain directly into the nose.
- External DCR: Performed through a small incision on the side of the nose near the inner corner of the eye; the scar fades over time. The success rate is high.
- Endonasal (endoscopic) DCR: Performed from inside the nose, without a skin incision.
According to a Cochrane review, mechanical endonasal DCR and external DCR have similar success rates (about 90%). Success is lower with laser-assisted endonasal DCR. We often place a fine silicone tube to keep the new passage open and remove it in the clinic a few months later. We can perform the operation under general or local anaesthesia, and patients usually go home the same or the following day.
After surgery
- Mild nosebleeds, swelling and bruising may occur in the first days; avoid blowing your nose for a while.
- You use antibiotic drops and nasal sprays.
- If you have a silicone tube, you may see it as a thin loop at the inner corner of the eye. Do not pull it out.
- At follow-up, the doctor assesses with a syringing test whether the watering has resolved.
Frequently asked questions
In external DCR, the surgeon makes a small incision on the side of the nose. In most patients the scar becomes inconspicuous over time. The endonasal approach involves no skin incision.
Congenital tear duct obstruction often opens on its own within the first year. Perform the massage of the sac as the doctor shows you; you may need antibiotics if there is discharge. If it does not open, the doctor plans probing.
Watering will continue and recurrent infections of the sac (dacryocystitis) may develop. Because of the risk of infection, we recommend treating tear duct obstruction before intraocular surgery such as cataract surgery.
Usually within 2–6 months; we remove it in the clinic in a few seconds; no pain is expected during the procedure.
References
- Jawaheer L et al. Endonasal versus external dacryocystorhinostomy for nasolacrimal duct obstruction. Cochrane Database Syst Rev. 2017;2(2):CD007097. doi:10.1002/14651858.CD007097.pub3
- Pediatric Eye Disease Investigator Group. Resolution of congenital nasolacrimal duct obstruction with nonsurgical management. Arch Ophthalmol. 2012;130(6):730–734. doi:10.1001/archophthalmol.2012.454
This page offers patient information and does not replace an examination or medical assessment. We determine the treatment that is right for you after an eye examination and measurements.
Watering eye and tear duct assessment
Prof. Dr. Fırat Helvacıoğlu · Veni Vidi Eye Clinic, Bağdat Caddesi No: 257, Caddebostan – Kadıköy, Istanbul, Türkiye