When the nasolacrimal (tear) duct becomes obstructed, a dacryocstorhinostomy (DCR) is often indicated. The primary goal of the surgery is to provide a pathway for tear drainage from the eye to the inside of the nose. The tear duct can be opened either endoscopically through the nose, or by an ‘open’ DCR which accesses the duct obstruction by making an incision along the nose. Dr. Baylin performs an endoscopic dacryocystorhinostomy (DCR). The endoscopic approach leaves no scars on the face like those of conventional open DCR which can also address possible intranasal problems that might lead to failure of the surgery. When patients are born with tear duct blockages, treatments are often different and less invasive.
DCR surgery is performed in an outpatient setting, under General anesthetic. Working endoscopically through the nose, your tear drainage system will be accessed, and a new, direct connection between your lacrimal sac and your nose will be created. This new route bypasses the duct that empties into your nose (nasolacrimal duct), which is the most common site of blockage. Silastic tubing is placed in the new route while it heals, and removed three or four months after surgery.
Recommended OTC medications to have available after surgery:
- Afrin Nasal Spray. Two sprays twice daily for 5 days.
- A sinus rinse kit. Start sinus rinse on second day after surgery then continue during the recuperation period.
- Flonase. Start on the day after surgery for 2months.
A nasal saline mist can be used every 3-4 hours per day to keep your nose moist and humidified.
AFTER THE SURGERY:
- Sinus Irrigations: You will start sinus irrigations with the sinus rinse kit 2 days after surgery, rinsing twice a day. The Post-Op nurse will show you how to perform the irrigations. This may feel strange at first but after a few rinse they will become quite soothing as they clean out the debris left behind in your nasal cavity after surgery. You can expect some bloody discharge with the irrigations for the first few days after surgery. These irrigations are critical for success after sinus surgery!
- Bleeding: It is normal to have some bloody discharge for the first 3-5 days after sinus surgery, especially after you irrigate your sinuses. If steady bleeding occurs after surgery, tilt your head back slightly and use Afrin nasal spray to help stop the bleeding. You can clear the nasal passage first by GENTLY blowing any clots out of the nose. Avoid strenuous activity for 2 weeks to minimize the chance of bleeding. If bleeding is excessive, call the office.
- Pain: The surgery is generally not painful. Some soreness on the side of nose may be present for a couple of days.
- The Tube: There will be a thin silicone tube in the corner of the eye. This will remain in place for 3 months following the procedure. It is important not to rub the inner corner of the eye so as not to disturb the tube. If the tube is pulled, it can dislodge. This is not dangerous. You can tape it to the side of the nose and make arrangements to have it repositioned. Of course, it is best to avoid pulling on the tube in the first place as it will not become displaced without disruption.
Specific instructions for post-operative care will be provided and explained at the time of surgery. As always, please call with any concerns or questions that are not addressed in your materials.