Endoscopic or external dacryocystorhinostomy (DCR)
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Depends on method of operation
Consultant Ophthalmic Surgeon
Oculoplastic Eyelid & Lacrimal Specialist
Canalicular bypass surgery involves doing an endoscopic dacryocystorhinostomy followed by insertion of a Lester Jones pyrex glass bypass tube.
At Clinica London, our substatinal experience in endonasal surgery means we usually do this operation as a primary or secondary endonasal endoscopic assisted procedure. This method allows us to check the correct position of the tube inside the nose during the operation, and to change its position if needed. Furthermore, the endoscopic technique is always useful to treat nasal pathology that can go unnoticed if we “don’t look inside the nose” and is sometimes responsible of a surgical failure.
The operation is done under general anaesthesia as a day case usually.
The preparation of the patient is similar for patients undergoing a DCR. The tube is fixed with a fine suture, which should not be removed as it will become safely buried.
After the operation the patient takes home topical treatment consisting in eye drops and nasal sprays to use several times a day during the first few weeks. Usually the Jones tube gives immediate relief from watering as it drains from the first day.
Acute dacryocystitis is treated using two methods:
- Treat the infection first with a course of antibiotics for up to one week, then treat the nasolacrimal duct obstruction. The definitive treatment is the dacryocystorhinostomy (DCR)
- Immediate endoscopic DCR can be done to treat both the infection and the nasolacrimal duct obstruction at the same time.