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Watering eye surgery success – A surgeon’s objective opinion

The patient has to get rid of their troublesome symptoms of watering, stickiness, discharge, lump at the side of the nose, or combination thereof. These are the symptomatic benefits of DCR surgery.
Ideally, I want the patient to have complete subjective improvement of their symptoms of watering eye after DCR surgery. Also, as an oculoplastic and lacrimal surgeon, I have to measure the success objectively using syringing the tear system to make sure there is a 100% patency and also nasal endoscopy to see that that there is a rapid endoscopic dye test. I want to see a rapid fluorescein dye disappearance test.
I want to know that the lacrimal system where I have made the new opening from the sac into the nose is now fully patent to syringing, without there being any effect on the cosmesis either externally or endonasally.
I also want the watering eye surgery success to be long term. A total success is better than a partial success. Making the symptoms better or improved is helpful, but is not as good as a total success. Ideally, I want the objective success to be completely patent to syringing, normal dye disappearance and normal endoscopic dye test, a good opening seen inside the nose with no problems of little scars, inflamed mucosa or membranes. I also want the patient’s subjective success to match my objective findings for my DCR operation for their watering eye to be considered a success.
The length of postoperative cure or success should be a lifetime, but it ‘s hard to follow-up the patient that long. In practical terms, most of our recorded patient series only follow-up for six months after surgery. I think a minimum of one year should be followed up if not even two years.
In summary, for DCR surgery for there to be a watering eye surgery success, subjectively there should be an elimination of the watering, stickiness, or both and elimination of other symptoms such as a swelling at the side of the nose, and also no new symptoms introduced because of the surgery. I want to find a 100% patency on syringing and see a functioning opening in the nose (called the lacrimal ostium). I do not want the patient to have a scar, and I want the result to be for as long as possible.
Reference: The Success Rates for Endonasal Dacryocystorhinostomy JM Olver, British Journal of Ophthalmology 2003; volume 83 part 11, page 1431.


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