A dacryocystorhinostomy is a hole which allows the lacrimal sac to drain tears freely into the nose. The process of creating this hole is also referred to as a dacryocystorhinostomy. This procedure is performed when the tear duct which normally drains the lacrimal sac becomes blocked, inhibiting the drainage of tears away from the lacrimal sac. Dacryocystorhinostomy procedures are usually performed by an ophthalmologist, a physician who specializes in eye care.
Someone with a blocked tear duct often experiences a condition called epiphora or excess tearing. Because the tears cannot drain from the eye into the back of the nose as they normally do, they spill out. Patients can also experience enlarged and inflamed lacrimal sacs, and may develop infections or inflammations around the eye. If a doctor suspects that a blocked tear duct is the problem, a tracer dye can be delivered into the eye and followed. If no dye appears in the nose, it indicates that the eye is not draining properly.
Historically, a dacryocystorhinostomy was performed by going in through the side of the nose to create a drainage hole for the tear duct. This usually left a small scar near the eye, and could lead to complications such as infections. Today, the majority of these procedures are performed endoscopically. In an endoscopic dacryocystorhinostomy, the doctor inserts a tube into the nose and uses it to introduce tools and a camera to see. This procedure allows the doctor to cut in precisely the right place, and to minimize removal of tissue and bone before inserting a stent to ensure that the dacryocystorhinostomy site remains clear and doesn't heal over to plug the hole.
When a dacryocystorhinostomy is scheduled for a patient, he or she will need to go to a hospital or ophthalmology clinic for the procedure. The surgery can be done under local or general anesthesia, and the patient can discuss these options with the anesthesiologist. Patients are usually asked to avoid eating for 12 hours before surgery, and they may be given prophylactic antibiotics to prevent infection.
The procedure takes around an hour, and the patient can usually go home on the same day. Some aftercare precautions and directions will need to be followed while the surgical site heals. The doctor will also usually ask that the patient attend follow up appointments so that the success of the surgery can be confirmed and for the purpose of checking on the stent to make sure it is still in place in the nose.
