Treating watery eyes with DCR surgery

Written by: Mr Daniel Ezra
Edited by: Nicholas Howley

If you are diagnosed with watery eyes, the main surgical option on offer is DCR surgery. We asked consultant ophthalmic and oculoplastic surgeon Mr Daniel Ezra how DCR surgery works, how patients can prepare, and what to expect after the operation.

What is DCR surgery?

DCR (dacryocystorhinostomy) surgery restores the correct flow of tears by creating a new drainage connection into the nose and bypass the blocked drainage duct.

DCR surgery is extremely effective. For most of our patients, the DCR surgery cures watery eyes in 90-95% of cases. For more complex cases, the success rate is between 70-80%.

There are two main ways of performing DCR surgery:

  • The “external” approach involves entering via the side of the nose, which leaves a very small and faint scar.
  • The “internal” approach uses modern endoscopic technology to go up through the nose and perform the surgery without cutting into the skin.

The external approach is often more suitable for patients with blocked tear ducts in the eye as well as the nose, whereas the internal approach is more convenient where there are sinus or polyp issues inside the nose that we can deal with in the same operation. You should always have a discussion with your doctor about which approach would be suitable for you.

How to prepare for surgery

Whichever type of surgery you have, you won’t be able to drive for at least 24 hours after the operation, so make sure you arrange for a family member or friend to pick you up afterwards.

We also recommend taking a week off work and avoiding strenuous exercise, so it can help to plan this in advance.

You will be advised not to take aspirin or ibuprofen in the two weeks leading up to the operation, and you should not eat or drink in the six hours before surgery.

Finally, before the operation you will have a meeting with the anaesthetist to assess your readiness for the operation and check what sort of anaesthetic you can take. DCR surgery can be carried out under general anaesthetic or local anaesthetic with sedation.

Recovery from surgery

Most people can go home once they have recovered from the anaesthetic, but older patients might need to stay in hospital overnight.

You shouldn’t drink alcohol in the 24 hours after surgery. It’s also important to stick to cold food and drinks – as hot food and drink can cause post-operative bleeding.

Finally, you will have a bandage on your eye and the side of your nose for the first 24 hours, but this can be safely removed afterwards.

What symptoms should I expect?

Nose bleeding after surgery is normal, but you should try to avoid blowing your nose for the first couple of weeks because this can make the bleeding worse. If you notice an excessively heavy amount of bleeding you should see a doctor immediately.

It’s normal to feel some pain in the area. You can take paracetamol or codeine for the pain, but do not take ibuprofen or aspirin until at least two weeks after the procedure. Meanwhile, ice packs can be useful in reducing any swelling and bruising.

Finally, your eyes might still water for a few weeks after surgery – but this should subside once the swelling has gone down.

What aftercare should I get?

After the operation you’ll be prescribed eye drops to take four times a day, and a nasal spray to loosen scabs in the nose. You should also have the following appointments:

  • 1-2 weeks after surgery, you will have a follow-up appointment. If you had an external DCR, the stitches on your nose will be taken out.
  • 4-6 weeks after surgery the temporary rod inside your nose will be taken out in an outpatient setting.
  • 6 months after surgery you should have final progress revier

What are the risks?

The main risk of DCR situation are:

  • Bleeding – this occurs in 1 in 50 patients but subsides after ten days
  • Blockages requiring more surgery
  • Infection

All surgical procedures carry risks. The good news is that with DCR surgery the risk of these complications occurring are very low – and they can be managed.

By Mr Daniel Ezra

Mr Daniel Ezra is an expert consultant ophthalmic and oculoplastic surgeon based in London, specialising in blepharoplasty, brow lift and chalazion alongside facial fat transfer, mid-face lift and oculo-facial plastic and cosmetic surgery. He privately practices at 9 Harley Street and Moorfields Private, the private division of the prestigious Moorfields Eye Hospital. He also works for the NHS at the same centre.

Mr Ezra is a full-time consultant for the Adnexal department at Moorfields Eye Hospital, where he is the head of the BoNT (Botulinum toxin, or Botox®) service, which predominantly deals with abnormalities of eyelid twitching and facial paralysis. He is also the endoscopic lacrimal (tear duct) surgery lead at the world-leading service.

Mr Ezra's skills as an oculoplastic surgeon were developed through his advanced subspecialty training at both Moorfields Eye Hospital, and as an Interface Fellow in cosmetic and reconstructive surgery in Nottingham, where he trained in plastic surgery, ENT surgery and oral and maxillofacial surgery alongside dermatology

His esteemed positions of Honorary Lecturer at the UCL Institute of Ophthalmology and Honorary Senior Research Fellow at City, University of London, reflect his strong interest in education. He frequently lectures both nationally and internationally, and is actively involved in the surgical training of medical students. 

Mr Ezra regularly speaks at international meetings, and is widely published, with numerous papers and book chapters to his name. His research work as a clinical lecturer for the National Institute for Health Research (NIHR) has received several prizes including a European Society of Ophthalmic Plastic and Reconstructive Surgery (ESOPRS) award, a BOPSS (British Oculoplastic Surgery Society) award and the British Thyroid Association (BTA) prize.

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