Endoscopic endonasal DCR or Dacryocystorhinostomy is the operation of choice for watering eyes from tear duct narrowing or full obstruction. Excessive tearing or troublesome watering with tears overflowing down the cheek can have many different causes, and there are several different surgical options, including DCR surgery. The Oculoplastic Surgeon carries out an initial watering eyes examination and can advise.
After a very careful examination by the oculoplastic surgeon to identify the underlying cause, he or she makes the treatment plan. Treatment most often involves surgery. However, if there is an eyelid problem, such as a lower eyelid sagging (ectropion), or a lower eyelid turning in (entropion), then the surgery will correct eyelid position. Watering eye from a blocked nasolacrimal duct is called epiphora. This happens when there is an abnormality of the lacrimal drainage system such as:
Surgery to improve the watering eye caused by a tear duct blockage is called a dacryocystorhinostomy or DCR. The endoscopic DCR is where the surgeon makes a small opening via the nose from the lacrimal sac into the nose above the blockage. This will allow the tears to flow unimpeded into the back of the nose and the patient will no longer have a watering eye.
Endoscopic endonasal DCR is done by an oculoplastic surgeon who has experience both in oculoplastics and working on the tear duct surgically from inside the nose using a rigid endoscope called the Hopkins rigid endoscope. The surgery is done under a general anaesthetic and takes about 45 minutes. If a combined endoscopic endonasal DCR and external DCR are done together, the LighTears DCR or COEXEN-DCR then can be done under local anaesthetic with sedation.
If the patient has excessive watering eyes epiphora from tear duct obstruction, the endoscopic technique is completely scarless. Many patients like it for that reason. There is actually a scar but it is invisible within the nose and not on the skin. Using the endoscope in the nose gives superb magnification and illumination which allows the surgeon to see the smallest and tiniest detail and helps improve the accuracy of the surgery, and therefore improve the overall surgical success rate. The results of purely endoscopic endonasal DCR with silicone tubes are in the range of 85% to 90% success where the original cause has been a blocked nasolacrimal duct.
If the cause is more complex, such as trauma or tumour, then the success rates will be proportionate to the severity of the cause. I have been doing endoscopic endonasal DCR and teaching this technique to my trainees over the last 22 years at the Western Eye Hospital and the Charing Cross Hospital. Now, in full-time private practice, I offer this technique back to patients who want to have the surgery performed through the nose without leaving any potential scars on the skin. It is the procedure of choice for the treatment of nasolacrimal duct obstruction where the patient wants completely scarless surgery.
Endoscopic endonasal DCR is a specialised procedure, which not all oculoplastic lacrimal surgeons offer. It is regarded as minimally invasive. It is in fact very similar to the external DCR except there is no cut through the skin and therefore no chance of scar afterwards. Access to the lacrimal sac through the nose is aided by using the Hopkins rigid endoscope for illumination, which has a small camera that attaches and magnifies the view inside the nose.
If a combined endoscopic endonasal DCR and external DCR are done, this is called LighTears DCR, and it carries a minute risk of scar in the tear trough area. Our experience of the combined approach, LighTears DCR or COEXEN DCR, is that it gives higher results than the endoscopic endolaser approach alone and is the scarring risk is minimal.
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