Watering eye surgery at Clinica London
The DCR operation (dacryocystorhinostomy) is the mainstay of watering eye surgery to relieve the patient of their tearing when an obstruction along the tear duct causes it.
The tear duct obstruction can be from wear and tear and constant re-inflammation of the tear duct lining. Tearing can also come from lacrimal stones within the tear duct, or by secondary causes of inflammation such as sarcoidosis, Wegener’s granulomatosis and even TB or a tumour.
Patients with sinus problems often get watering eye problems because there is a gradual narrowing of their tear ducts from mucosal inflammation. This narrowing causes tears to drain more slowly.
An oculoplastic surgeon does DCR surgery. DCR is most commonly done nowadays from inside the nose when it is called an endoscopic endonasal dacryocystorhinostomy or Endo DCR for short. Endo DCR is best done under a general anaesthetic and takes about 45 minutes to an hour.
At the surgery, I make a new opening in the tear duct from the tear sac, into the sidewall of the nose. This opening is deeply buried inside where you will not be aware that the surgery has been done once it has healed. Soft silicone tubes are placed at the end of the surgery, which remains there for three to four weeks. During the first few weeks, the patient puts in eye-drops, nasal sprays and uses a nasal douche.
Some patients do not want to have a full general anaesthetic and prefer to have a local anaesthetic with sedation. For these patients, the best option is to do an operation, which is a combined external approach via a short skin crease incision in the tear trough, together with an endoscopic endonasal approach through the nose.
This combined approach DCR is called LighTears DCR or COEXEN-DCR. I have noticed that after 22 years as a consultant and 34 years as an ophthalmologist that the combined approach under local anaesthetic gives the very best results. The reason for this is that there is good access through the small skin incision and then brilliant visibility through the endoscope. So the surgeon and the patient gets the best of both worlds.
The nasal endoscope used for the endonasal part of the DCR is attached to a camera, which is connected to a TV screen monitor. This monitor shows the area of the DCR magnified and very clear so that the smallest fragments of tissue that have to be removed can be seen and accurately removed. The endoscope has a very bright torch light on it, which helps with visibility as well as its magnification capacity. There are real benefits in the surgeon seeing the image remotely on the screen.
The skin incision allows excellent access to the bone because a small bony hole has to be made. The tear trough skin incision enables good access and is closed with four or five little sutures (stitches) at the end of the surgery, which after removed, gives a barely visible scar.
The third type of DCR is the purely External DCR, which is approaching the DCR through a skin incision but without the nasal endoscope. External DCR, for many years, has been regarded as the gold standard but does not have the advantages of being able to see in the nose and the surgeon being aware of everything that is going on from a nasal aspect and operating from within the nose. However, I think the new platinum standard is indeed the combined external and endoscopic DCR called COEXEN-DCR or LighTears DCR.
To find out which watering eye surgery would work best for you, contact us.
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