Dacryocystorhinostomy (DCR) to Treat Blocked Tear Ducts


The eye in order to function properly should have a smooth and lubricated surface. Tears are responsible for this task; they keep the surface of the eye smooth and clear, protect the eye from dust and contaminates, and, on the other hand, improve the eye and visual performance. In some people, tears cannot drain properly for different reasons. For example, in patients with nasolacrimal duct obstructions, the blockage prevents normal tear drainage and can cause significant discomfort and irritation.

A partial or complete obstruction in the tear drainage system can be treated with dacryocystorhinostomy (DCR), which is performed precisely at Motahari Noor Subspecialty Eye Clinic.

A DCR is the surgical creation of an opening between the lacrimal sac and the nasal cavity to form a new drainage channel for tears, from which tears flow into the nose. DCR surgery is done in two ways:

1. External DCR: During this procedure, first a 1-2 cm incision is created in the inner corner of the eye and on the outer wall of the nose to access the tear sac.

DCR surgery should be performed by an ophthalmologist, preferably an oculoplastic surgeon. In some patients, a soft silicone cord (often called tubes) may be put into the tear passage to keep the new drainage channel open during healing. The two ends of the silicone tube are tied together and create a knot in the nose. This tube is removed in clinic outpatiently one to several months after the operation.

2. Internal/Endoscopic DCR: In this operation the tear sac is reached from the inside of the nose, using a small telescopic instrument called an endoscope. Since there is no cut in the skin for this operation and it leaves no visible scarring, some patients are choosing this method.

Oculoplastic surgeons of Motahari Noor Subspecialty Eye Clinic, prescribe a CT Scan of the paranasal sinuses as a necessary pre-operative examination for all candidates for DCR surgery, because in the presence of nasal problems such as nasal septum deviations, sinusitis, etc. there is a risk of failure of DCR surgery. In these cases, for a successful surgical outcome the ophthalmologist needs to consult an ear-nose-throat (ENT) surgeon.

In fact, Endoscopic DCR, should be done as a team work by an ophthalmologist (oculoplastic surgeon) and an ear-nose-throat (ENT) surgeon.

One of the advantages of internal/endoscopic DCR, in addition to the lack of surgical scar on the skin of the patient, is that the patient’s nasal and tear duct problems can be solved at the same time during a surgery, instead of undergoing two separate surgeries and anesthesia events.

The success rate of this surgical procedure is more than 95%. Endoscopic DCR surgery for the first time in Iran was performed at Motahari Noor Eye Clinic and up to now over 800 endoscopic DCR surgeries, with success rates of higher than 95%, have been performed in this clinic.

Fortunately, surgery and operating room team of Motahari Noor Eye Clinic have gained enough experience in carrying out DCR surgery and if it necessary, they have enough experience and all the advanced facilities for performing two procedures of endoscopic DCR and nasal surgery simultaneously.

We are honored that today, many patients from all over Iran are referred by many of Iranian ophthalmologists and ear-nose-throat (ENT) specialists to Motahari Noor Eye Clinic for undergoing endoscopic DCR surgery.