Having a dacryocystorhinostomy

A dacryocystorhinostomy (DCR) is a surgical procedure that can be used to treat blocked tear ducts.

Preparing for your surgery

You will attend a pre‑assessment appointment with a nurse, where you will be given more information and have the chance to ask questions. 

You may need further tests, such as blood tests or an electrocardiogram (ECG). 

Changes to your medicines 

You might need to make some changes to your medicines before the surgery. 

You should let us know if you:

• are taking any blood-thinning medicines, such as antiplatelet medicines (for example aspirin or clopidogrel) or anticoagulant medicines (for example warfarin or rivaroxaban), as you might need to stop them temporarily before your surgery
• have diabetes, as you might need to change the dose of your diabetes medicines, when you fast (stop eating and drinking) before the procedure
• are taking any regular medicines (including anything you buy from a pharmacy or shop, and any herbal or homeopathic remedies)
• have any allergies to any medicines

Fasting (not eating or drinking) instructions 

To keep you safe during the anaesthetic, it is important to follow the fasting instructions carefully.

Do not eat or drink anything (except non-fizzy water) for 6 hours before your appointment. This means that you cannot suck on sweets or chew gum.

You can drink water up to 2 hours before your appointment.

If you continue to eat or drink after this, your surgery will be cancelled.

On the day of surgery

Please wear comfortable, loose-fitting clothing on the day of surgery.

You should arrange for a responsible adult who can help you on your way home. They might also need to stay with you for at least 1 day after your treatment.

During surgery 

During a DCR, the surgeon opens the tear sac and connects it directly to the inside of the nose, creating a new drainage pathway. This involves removing a small amount of bone between the tear sac and the nose. 

The tear sac can be reached either through the inside of the nose (endoscopic DCR) or through a small incision on the side of the nose (external DCR).

External DCR

The surgery is done through a small 10mm to 15mm cut (incision) on the side of your nose. This usually heals well and is rarely noticeable once healing is complete. You will have stitches, which are usually removed 7 to 14 days later.

As part of the procedure, a small polythene tube is placed inside. This does not help with drainage itself but helps keep the new passage open while healing takes place. The tube is usually removed after 6 to 12 weeks.

Endoscopic DCR

Endoscopic DCR is a minimally-invasive procedure to unblock tear ducts. The operation is very similar to external DCR, but there is no cut through the skin and no scar afterwards. Access is through your nose, using a small thin camera (endoscope). A small tube will be placed internally, positioned in the newly created passage. This will be removed after 4 to 6 weeks.

Removal of the tube

The tube may be visible just inside your nose, but do not worry if you cannot see it. It will be removed at a follow‑up outpatient appointment.

The tube is secured inside the nose, and sometimes a small loop can be seen at the inner corner of your eyelids. If this happens, the soft tube can usually be gently pushed back into place.

After your surgery

At the end of the procedure, a silicone tube is usually placed in the new tear drainage system. The ends of the tube sit inside your nose. The tube stays in place for around 1 to 2 months.

You must not blow your nose for 2 weeks, but you can wipe your nose or sniff to clear it. If you sneeze, try to keep your mouth open.

A firm dressing will be placed over your eye. You can remove it the following morning.

You'll be given antibiotic eye drops and eye ointment to use in the operated eye. It's important to wash your hands before and after using these medicines, reduce the risk of infection.

You should follow our instructions on wound care. 

Leaving hospital

We recommend that you have a quiet evening after your surgery. 

Hot food and drinks should be avoided for 2 days after surgery as they can trigger bleeding.

For 24 hours after surgery:

Symptoms after surgery

You might have blood-stained oozing from your nose. This usually stops after a few hours.

If bleeding occurs, apply an ice pack to the bridge of your nose on the opposite side to the dressing. You can use an ice pack or frozen peas wrapped in a tea towel. Never apply ice directly to your skin. Gently wipe away any bleeding with a tissue.

If you have any pain, you can take paracetamol or codeine. 

Do not take aspirin or ibuprofen for 2 weeks, as this increase the risk of bleeding. Always check the instructions on medicine packets to avoid products containing aspirin.

It's common for your eye to continue watering for weeks after surgery. This usually improves as swelling settles and the tube is removed. 

Your vision might be blurred for few days and you might not be able to wear contact lenses during this time. 

Wound care 

Keep your wound dry and uncovered. 

We usually ask you to start nasal douching (washing out your nose) after 1 week and to continue this for several weeks. Sterimar™ saline nasal spray is commonly recommended and can be bought from a pharmacy.

If you have stitches, these may be left in place or removed after 1 to 2 weeks. We'll arrange an appointment for you in the outpatient clinic.

Resuming your normal activities

You might want to take a few days off work, depending on your circumstances.

You should not resume any strenuous activity, including swimming, for 2 weeks.

Follow-up appointments

A follow-up appointment for a few days after your surgery will be booked for you before you leave the hospital. It will take place in the eye department at St Thomas’ Hospital.