Laser DCR( Laser Dacryocystorhynostomy)-Creating a new tear drain
What is DCR?
DCR, or dacryocystorhynostomy, is a surgery performed to create a new tear drain between the eye and nose when your current tear drain becomes blocked or obstructed.
What is the anatomy?
Tears generated by the tear glands in your eyes need to be drained to the nose. The tear drain consists of two small openings called punctum; one in your upper eyelid, and the other in your lower eyelid. Each of these openings leads into a small tube called the canaliculus, which, in turn, empties into the lacrimal sac between the inside corner of your eye and your nose. The lacrimal sac leads into a canal called the nasolacrimal duct that passes through the bony structures surrounding your nose and empties tears into your nasal cavity.
How does the tear drain function?
When you blink, your eyelids push tears evenly across the eyes to keep them moist and healthy. Blinking also pumps your old tears into the puncta and lacrimal sac where they travel through the tear duct and drain into your nose. If your tear duct is blocked, your tears back up and spill over your eyelids as if you were crying. Tears blocked in the lacrimal sac can also become stagnant and get infected. A DCR can be performed to correct this condition.
What are the symptoms of having a blocked and infected tear drain?The most common symptoms are excessive watering, mucous discharge, eye irritation, and painful swelling in the inner corner of your eyelids. A skillful history and physical examination can usually pinpoint the cause of excessive tearing and blockage. If your symptoms go untreated, an infection can develop around your eye.
What are the treatments?
Your eye surgeon may recommend a number of treatments based on an analysis of your symptoms. In some instances, it may be as simple as applying warm compresses and anti-biotics, but often, surgery is the most effective treatment.
DCR surgery involves creating a new tear drain opening from the blocked sac directly into your nose to bypass the obstruction. Conventional DCR surgery has been performed since the 1900’s and has high success rates. Conventional DCR surgery involves creating a flap of the skin at the side of the nose, exposing the bones protecting the nose, and creating an opening in this bony cover and the soft tissue inside the nose. The flap is then sutured back in place. In some cases, a thin silicone tube can be inserted into the new drain and tied in the nose to keep the new drain open till the healing process is over.
Subsequently, this tube is removed.
What is Laser DCR surgery?
Conventional DCR surgery is quite long, and complicated. It can involve significant blood loss, which can cause severe complications in a small minority of patients. The requirement for raising a flap of the skin and the subsequent sutures leaves behind a fine scar on the face. It is difficult to repeat if the new drain also gets blocked. There is a significant healing process, and recovery time can be as long as a couple of weeks.
Recently, a new innovation involves the use of a laser which has high absorbtion in both water and blood. A thin tube is inserted into the punctum, and passed through the canaliculus, till it reaches the position where the new tear drain has to be opened. A very thin optical fiber is then inserted into this tube, and laser energy is delivered to cut through both the bony and soft tissue and into the nose. This opening is then enlarged.
Thus a new tear drain is created. Most of the disadvantages of conventional DCR surgery are avoided. First, the surgery is quick and easy. Second, there is very little likelihood of severe blood loss or severe complications. Third, there is no scar. Fourth, the recovery is immediate. And finally, in case the new drain gets blocked, it can easily be reopened.
Laser DCR is generally performed as an outpatient procedure, which means that the patient does not need to stay in hospital. It is generally done under local anesthesia, which means that the patient is merely sedated with intravenous medications. The patient may need to put some eyedrops for a couple of months. The patient may also need to visit the eye surgeon for a few times for follow-up over the next couple of months.
In some cases, a thin silicone tube may be placed inside the new drain to act as a stent (i.e., to keep the new passage open). This tube is generally removed after a few weeks.
What are the risks and complications of Laser DCR?
As with any surgery, Laser DCR can also have some complications, like infection or anesthesia related complications, which you should discuss with your eye surgeon. In general, however, the risk of such complications is smaller with Laser DCR, than with conventional DCR surgery. The may be the uncommon risk of laser burns around the nose. This is however, quite rare.
In some cases, scar tissue develops inside the nose, blocking the drain again. This necessicitates repeating the procedure.
Is Laser DCR surgery effective?
Most patients experience resolution of their symptoms, like tearing and discharge, once laser surgery is completed, with little or no discomfort.
Where Can I get Laser DCR surgery done?
Only our Vadodara centre offers the Laser DCR procedure, a symptom of our continuing commitment to adopting innovations in eye care.