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Dacryocystorhinostomy

AMBULATORY CARE:

A dacryocystorhinostomy (DCR)

is surgery to help tears drain. It is used when the nasolacrimal duct is blocked. This is the main tear duct that allows tears to drain from the eyes. A new drain system will be created by joining your lacrimal sac with your nasal cavity (inside of the nose). Tears will drain directly into your nasal cavity.

How to prepare for surgery:

  • Your surgeon will tell you how to prepare. He or she may tell you not to eat or drink anything after midnight on the day before surgery. Arrange to have someone drive you home when you are discharged.
  • Tell your surgeon about all medicines you currently take. He or she will tell you if you need to stop any medicine for surgery, and when to stop. He or she will tell you which medicines to take or not take on the day of surgery.
  • Tell your surgeon about all allergies you have. Tell him or her if you had an allergic reaction to anesthesia or antibiotics.
  • A CT or MRI may be used to check the surgery area. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the healthcare provider if you have any metal in or on your body.

What will happen during surgery:

  • You may be given general anesthesia to keep you asleep and free from pain during surgery. You may instead be given local anesthesia to numb the area. You will be awake with local anesthesia, but you should not feel pain. Material soaked in anesthesia may be packed into your nose. The packing may also have medicine to help control bleeding. Packing may also be needed to remove extra mucus.
  • For open surgery, your surgeon will make an incision next to your nose. For endoscopic surgery, your surgeon will put an endoscope into your nose. If he or she has trouble getting to or seeing the area, a septoplasty may be needed. This is surgery to straighten your septum (tissue that separates your nostrils).
  • A small piece of bone will be removed so your surgeon can create a connection between the lacrimal sac and nasal cavity. A stent may be placed to keep the created duct open. If you had an incision, it will be closed with stitches and covered with a bandage.

What to expect after surgery:

  • Medicines may be given for pain and inflammation. Medicines may also be given to help prevent infection and congestion.
  • Packing made of a gauze dressing may be put into your nose to decrease bleeding. This will be removed 1 to 3 days after your surgery. Bandages will be placed below your nose to catch any blood or fluid that comes out.
  • Swelling or bruising is expected and should get better in a few days. An ice pack will be placed on your nose after surgery to help decrease swelling. You may have nosebleeds for a few weeks after surgery.
  • Nasal rinses help clean your nasal cavity and prevent infection. Healthcare providers will rinse your nose with saline. You will need to use nasal rinses and sprays each day for the first 3 weeks. You will not be able to blow your nose until your healthcare provider says it is okay. The nasal rinses and sprays can help keep your nose clear in the meantime.
  • You may need to wait up to 4 weeks to notice an improvement in your symptoms.

Risks of a DCR:

You may bleed more than expected or develop an infection. You may have a permanent surgery scar if your surgeon made an incision. Tissue in your nose may be fused. A tube used to keep the new duct open may fall out or move out of place. Surgery may not work, and you may continue to have watery eyes.

Seek care immediately if:

  • You have trouble breathing.
  • You have severe pain.
  • You have red streaks on the skin around your nose.

Call your doctor or surgeon if:

  • Your symptoms do not improve within 1 week.
  • Your nose bleeds more than you were told to expect.
  • You have a fever.
  • Your nose is red, swollen, and draining pus.
  • Your upper teeth, gum, or nose is numb.
  • Your sense of smell or taste is different than before surgery.
  • You have a change in your vision.
  • You have questions or concerns about your condition or care.

Do not blow your nose:

The increase in pressure can cause bruising, swelling, and bleeding. Try not to sneeze. If you have to sneeze, keep your mouth open to decrease pressure in your nose. Use a nasal spray as directed to remove mucus and to keep your nose clear.

Apply ice:

Apply ice on your nose for 15 to 20 minutes every hour for the first day. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel. Ice helps prevent tissue damage and decreases swelling and pain.

Elevate your head and upper back:

Keep your head and upper back elevated when you rest, such as in a recliner. Place extra pillows to support your head, neck, and shoulders when you sleep in bed. Elevation will help decrease swelling.

Self-care:

  • Rinse your nose with saline, as directed. Mix ½ teaspoon of salt and ¼ teaspoon of baking soda with 1 cup of warm distilled water. Nose rinses help remove crusts and prevent infection. Apply petroleum jelly to your nostrils after you rinse your nose. You may have gauze taped under your nostril openings. Change the gauze if it gets wet or dirty.
  • Use a cool mist humidifier. A cool mist humidifier will increase air moisture in your home. This will help keep your nose and throat moist and prevent irritation.
  • Limit activity for 3 days or as directed. Do not lift objects over 20 pounds. Ask when you can return to your usual daily activities.
  • Do not smoke for at least 2 days after your surgery. Smoke can irritate your nose and delay healing. Nicotine and other chemicals in cigarettes and cigars can also cause lung damage. Ask your healthcare provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products.

Follow up with your doctor or surgeon as directed:

You may need to return for tests to check the surgery area. Stents may also need to be removed. Write down your questions so you remember to ask them during your visits.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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