What is LighTears DCR?
LighTears DCR is an operation for watering eyes which is done under local anaesthetic with sedation. It is very suitable for older patients not wishing to have a full general anaesthetic and the potential risks associated with a GA.
Elderly patients with watering eyes from a blocked nasolacrimal duct often need a small operation to help drain tears from above the tear duct obstruction. The tear duct obstructs more in women than men and increases with older age.
Older people usually do not want to have a full general anaesthetic and often much prefer to have a local anaesthetic procedure with a little bit of sedation.
With LighTears DCR, the surgery is lighter. A lighter surgery means a few things:
- an older patient can sit partly upright for the surgery
- a local anaesthetic is given around the area where the DCR will be done on the skin side
- the nose is sprayed with some local anaesthetic, and the endoscope is used to monitor the surgery and to assist with the more delicate parts inside
- the patient is monitored during the procedure.
Unlike the endoscopic endonasal DCR, where a drill is used, and a lot of fluid is irrigated to stop overheating from the drill, the light DCR does not use a drill nor irrigation. It does use some instruments to remove the bone to make the little opening through the bone from the lacrimal sac to the nose. But because of the local anaesthetic, this is extremely well tolerated.
The silicone tubes are placed in a usual way for a DCR, and the mucosal edges are stitched together using a combination of magnifying loops viewing from the outside (skin side) and the endoscope illuminating and magnifying from the inside of the nose.
Because the patient is awake, their recovery is much faster than a general anaesthetic, and they only have to be in the hospital for around four hours. The surgery takes about 35 to 45 minutes, and at the end of the procedure I put a little pack into the nose just to make it feel comfortable and capture any drips that may be present.
I also pad the eye overnight, which the patient takes off at home the day after and then they start putting in eyedrops and nasal sprays. I see them a week after surgery to remove the stitches from the tear trough area. The little incision on the skin heals very well and does not leave a visible scar. The results of the light DCR are excellent in the range of 98% success.
LighTears DCR or combined external approach endoscopic endonasal DCR (COEXEN-DCR) is the preferred treatment for watering eyes at Clinica London for elderly patients who do not want to have a general anaesthetic but prefer a local anaesthetic and a rapid recovery. They can get a bruise but are warned about that, and any bruising usually disappears between 5 and ten days after surgery.
We give antibiotics during the surgery to prevent infection afterwards, and they are given antibiotic drops to put in the eye four times a day for the first three weeks, plus nasal spray and nasal douche to assist washing out residual absorbable packing and little clots.
I take the silicone tubes out in the clinic under topical anaesthetic three weeks after LighTears DCR when we know for sure that the surgery is working and not just being held open by the tubes.
After the tubes are removed, I see the patient between one and two weeks afterwards and syringe through the tear duct to establish it is patent, and also inspect inside the nose. More about what happens after DCR surgery in a future blog post!