Risks for DCR

[MLStein]

I have had an intermittent tearing in my right eye for about 2 and 1/2 years.  The eye can be fine for months at a time, and then it starts to tear for a few hours, and then it finally starts to tear 24/7.  I have had probing done twice, both times successfully, but the doctors I have seen have told me that the tearing is very likely to return unless I get a DCR.  Because my septum is so deviated to the right, my doctor has advised an open DCR rather than an endoscopic, which would require a septoplasty.

Anywhere, I would like to know what the risks and possible complications of a DCR are.  I know that I can expect tearing until the tubes are moved, but what else is possible?  Is there a possibility that I will have problems with air from the new hole in my nose blowing across my eye?  I've read that some people who have DCR have this complication, and frankly, it worries me.  Thanks for any help.

[Michael J Kutryb, MD]

I would not recommend DCR unless the duct is completely and permanantly blocked AND you are getting recurrent bouts of dacryocystitis (red, infected, very sore and bulging lacrimal sac) and or recurrent bacterial conjunctivitis due to the stagnant tears stuck in the sac.  Remember we plug the lacrimal puncta all the time on purpose for dry eyes and  worst thing that can happen is teary, watery eyes.  Unless you are getting recurrent infections, I would leave it alone but you will have to take care of the eye daily with massage of the lacrimal sac and cleaning out the eye as needed and using antibiotic drops when needed.  Your doctor should be able to explain all this to you.

MJK MD

[Michael J Kutryb, MD]

I'm not a huge fan of endoscopic dcr anyway.  I've seen about a 30% failure rate with the endoscopic patients and only about 5% or less with traditional dcr.  I  have never heard of a patient actually having the air blowing out over the eye but I know that it is possible.  I, personally would not be too concerned about that.  The risks of the DCR include bleeding, infection, failure and scarring.  If you are young and or are into looks, you might not be crazy about the scar (although it is usually much less than you might think) but again a teary eye full of mucous is not all that attractive.  I think it would be a great idea if you could actually see in person what the scar usually looks like.  Make sure you are seeing a board certified ophthalmologist that specializes in orbital and plastic reconstructive surgery.

MJK MD

[Superdork]

A related discussion, DCR and risks was started.

[Michael J Kutryb, MD]

I'm OK with a teenage girl having endoscopic DCR - I think that's fine and she will like not having the scar.

MJK MD

[MLStein]

You have to use an oculo-plastic surgeon for this type of surgery.  Go to or call a general eye doctor and ask for the names of that kind of surgeon in your area (that's how I found my surgeon).  The general eye doctor will know who in your area to send you to.  You have to get a reference to see most of these doctors anyway.  Good luck and hang in there.

[SueRL]

My problem is very much like yours.
I am looking at some type of intervention.
Can we ask on the boards, who their doctor is?
I am trying to find a doctor who does the internal type of surgery.
Please reply.  If we can't post doctor's name, maybe we can
talk email to email.
I am getting upset about this situation.  Eye is getting worse.
Thanks,
Sue

[MLStein]

I was the original poster in this thread, and I wanted to follow up.  After discussions with my surgeon, I underwent a DCP on my eye, rather than an DCR.  As the doctor explained it to me, he uses a balloon catheter to enlarge the nasolacrimal duct.  Since I had intermittent tearing, he thought that using the less complex procedure first was indicated.  I had it last week and there was almost no pain post-op, and just a little redness in the corner of my eye.  (The general anesthesia was no fun, however.)  I'm happy to report that my duct is draining properly.  The nostril on the side where the procedure was performed is still congested, but I don't know whether that's because of the procedure or maybe I have a mild cold.  I see the MD next week and ask him.  So far, so good, and I'm hoping that I'll be able to avoid having the more complicated DCR in the future!

[meggs581]

My daughter is 13 years old and has had 2 probings at age 2 and then a tube placed in her nose for approx. 1yr. All procedures were unsuccessful. The Dr. at the time suggested that we wait a few years to see if she will outgrow this condition. She is now 13 and very self-conscious about her eye. We recently brought her for 2 opinions. One Dr. just spoke about the external DCR. The other  Dr. spoke about the external and internal DCR. We would like to get the internal DCR so we can avoid a scar. He showed us where the scar would be and did explain that the external DCR success rate is a little higher than the internal DCR. He does both procedures frequently, but said that if it were his daughter, he would opt for the internal DCR. I was wondering if you caould give me youy thoughts on this matter.
Thank you

[MLStein]

Thank you for getting back to me, Dr. Kutryb.  I will definitely go back to my doctor and talk to him again.  It's pretty miserable when the eye is constantly tearing, because I can't work for more than a few minutes without stopping to lift my glasses and wipe my eye, but maybe I should wait until I have a problem again.

I appreciate you providing advice to me about this.

[MLStein]

Thank you for answering my question about the risks of a DCR so quickly.  I hope you don't mind answering another one.

I'm not worried about the scar -- my doctor showed me where it will be and since I always wear eyeglasses, it would hardly be visible, even to me.  But here's my concern.  The surgery would be on the right eye, which is my "good" or "dominant" eye, as I have amblyopia and strabismus (corrected twice with surgery, once as a child and once as an adult).  I have always been warned about protecting my "good" right eye due to the amblyopia, so any surgery on the right side is scary to me.

Since the last probing was done in December 2007, my eye is draining tears properly 95% of the time.  If I were your patient, would you recommend leaving well enough alone and having the DCR when I again have a problem or should I have the DCR before trouble arises again?  I can see the advantages of getting ahead of the issue, given the likelihood that it will reoccur, but I wonder if it makes sense to undergo surgery before there's a problem. Thanks again for any help you can give me in making this decision.