DCR & Probing

In children, nasolacrimal duct obstruction is mainly congenital, and is often resolved spontaneously and with lacrimal sac massage by age one, but in adults, especially some middle-aged and old women, as you age, lacrimal duct inflammation due to inflammatory processes such as chronic sinus infection (sinusitis) or severe conjunctivitis, causes the lacrimal duct to get narrower and eventually blocked. Sometimes nasal or facial fractures can also cause mechanical obstruction of the lacrimal ducts. Prolonged nasolacrimal duct obstruction usually results in lacrimal sac infection

Patients with lacrimal duct obstruction, usually refer to Dr. Shahidi’s office complaining about excessive tearing (Epiphora) and sometimes pus exiting the inner corner of the eye. In these patients, tears are chronically and permanently flow out of the affected eye onto the cheekbone, so that patients always have to wipe the affected eye with a napkin, even while they are at home. In the case of prolonged lacrimal duct obstruction, infection and acute inflammation of the lacrimal sac can occur occasionally, presenting as severe, red, painful swelling in the inner corner of the eye, between the eye and the nose that requires immediate treatment

Non-surgical treatments include supervision, lacrimal sac massage and topical antibiotic use. Massage requires that you wash your hands and place your forefinger on the inner side (nose side) of the eye and press down. You may also be asked to use a warm compress. If there is an infection, it is useful to use an ointment or topical antibiotic eye drops

If the lacrimal duct obstruction does not resolve after several months with the above mentioned treatments, there’s a severe infection or your child has recurrent infections, then probing is required, that is successful in 85-95% of children under one year of age, but the likelihood of success decreases as the child ages. Probing is a surgical procedure that takes about 10 minutes in which a thin metal instrument (probe) is passed through the blocked tear duct to open the blockage. Some physicians believe that the best appropriate age is 6 months, which can be performed in the clinic without general anesthesia, but some believe that probing can be delayed by one year of age to give the child the best chance of spontaneously opening the duct. Probing is performed in the operating room and under general anesthesia

Nasolacrimal duct obstruction can be treated by stenting or nasolacrimal duct intubation only under the age of two to three years; but at an older age, nasolacrimal intubation is only a diagnostic procedure and is not recommended for treatment at all. Therefore, to treat nasolacrimal duct obstruction in adults, a surgery called Dacryocystorhinostomy (DCR) is performed during which a lacrimal duct is opened directly into the nose. The surgical procedure is to make a small incision in the area between the eye and the nose on the outer skin of the nose to reach the lacrimal sac. Then a small piece of bone between the lacrimal sac and the nose is removed. At this stage, an incision is made on the lacrimal sac and then the edges of the incision are sewn to the nasal mucosa in such a way that there is a direct connection between the lacrimal sac and the nasal cavity. Usually, a silicone tube is also temporarily placed into the lacrimal duct to prevent re-obstruction after surgery. This tube has no pain and does not cause any problem for the patient

Things to consider before surgery

Since water should not contact the wound until forty-eight hours after surgery, bathe and shave the day before surgery. The surgery is usually performed under general anesthesia, so you have to be fasting (hungry), in the operating room, therefore, you should stop eating food and drinking water at least eight hours before the surgery. If you have high blood pressure, take your blood pressure pills with half a cup of water in the morning of the surgery. If you have diabetes and take diabetes pills, take half of your usual pills the night before surgery, and avoid taking diabetes pills in the morning of surgery

Things to consider after surgery

For one week after surgery avoid bending your head down, eating and drinking hot and cold foods and liquids, because not observing the above mentioned tips can lead to severe nosebleed

To prevent nosebleed, apply cold water or even ice compresses on the area for up to 24 hours after surgery. Since this surgery is usually associated with a lot of bleeding during the surgery and even one or two days after surgery, have a proper and nourishing diet after the surgery so that your body can replace and make up for the lost blood and iron. If you have severe nosebleeds after the surgery, refer to a hospital emergency room equipped with ENT facilities. The sutures are removed one week after the surgery and the rhinoplasty scar on nasal skin will also heal gradually within 3 months. There may be some tears as long as the silicone tube is in the nasal cavity that will be resolved by removing the tube. The silicone tube is removed through the nose 4 to 6 months after the surgery in the office without any need for anesthesia or numbing. The probability of success in treatment of nasolacrimal duct obstruction with open surgery (DCR) is about 95%.