Endoscopic Tear Sac Surgery

Endoscopic Tear Sac Surgery (DCR)

Endoscopic tear sac surgery is a minimally invasive surgical procedure to open blocked tear ducts and restore tear drainage.
Tears keep the surface of the eye moist and clean.
Normally, tears drain into the nasal cavity through tear ducts in the inner corner of the eye.
However, when these ducts are blocked, tears accumulate in the eye and the problem of constant watering (epiphora) occurs.
Endoscopic tear sac surgery is one of the most effective and up-to-date treatment methods to relieve this blockage.

What is Tear Duct Blockage and Why Does It Occur?

Tear duct obstruction refers to conditions that prevent tears from draining into the nasal cavity.
This obstruction is characterized by persistent watery eyes, swelling in the tear sac area and recurrent infections.
The main causes of blockage are:

• Congenital Anomalies: Some people may have congenitally closed tear ducts.
• Infections Chronic tear sac infections (dacryocystitis) can lead to blocked tear ducts.
• Traumas Trauma to the nose and eye area or accidents can cause damage to the tear ducts.
• Sinusitis and Nasal Congestion: Sinus infections and nasal congestion can affect the tear duct and impede drainage.
• Aging With aging, the tear ducts may narrow and lose their function.

Symptoms of Tear Duct Blockage

Tear duct blockage is usually characterized by persistent watering and discomfort in the eye.
Common symptoms of this condition include:

• Constant watering of the eyes: Excessive watering of the eyes, especially in cold weather or with the effect of wind.
• Redness and swelling around the eye area: Swelling, redness and tenderness may occur in the tear sac area.
• Eye Discharge A yellowish or white discharge may be seen in the eye due to congestion.
• Tear Sac Infection: Infection of the lacrimal sac can occur frequently and can be characterized by pain and swelling.

What is Endoscopic Tear Sac Surgery (DCR)?

Endoscopic tear sac surgery (Endoscopic Dacryocystorhinostomy, DCR for short) is a surgical procedure performed through the nose to unblock the tear duct.
Unlike traditional surgical methods, endoscopic DCR opens the tear ducts by accessing the nasal cavity without any incision on the face or skin.
This method offers less pain and a faster healing process due to its minimally invasive nature.

Preoperative Preparation

Before endoscopic DCR surgery, the patient’s complaints and the condition of the tear duct are evaluated in detail.
What needs to be done in this process:

• Eye and Nasal Examination: The condition of the tear ducts, the location and cause of the obstruction are determined by a detailed examination.
  Intranasal structures are also evaluated by endoscopic examination.
• Tear Duct Tests: In order to evaluate the patency of the tear ducts, tests performed by giving fluid into the tear duct are applied.
• Imaging: Computed tomography (CT) or magnetic resonance imaging (MRI) can be performed to examine the structure of the lacrimal sac and ducts.
• Medication Use: The use of blood thinners should be discontinued before surgery.
  Antibiotics may also be recommended before surgery to reduce the risk of infection.

How is Endoscopic DCR Surgery Performed?

Endoscopic DCR surgery is performed under general or local anesthesia and takes approximately 30-60 minutes.
During the procedure, a thin endoscope is inserted into the nose and a camera is used to access the lacrimal sac.
The main stages of the surgery are as follows:

1. Placement of the Endoscope: The endoscope inserted into the nose allows the surgeon to clearly see the blocked part of the tear duct.
2. Opening the Duct The blocked tear duct is widened by creating a small window opening into the nasal cavity.
   Laser or surgical instruments can be used during this procedure.
3. Stent Placement: A thin silicone tube (stent) is inserted into the tear ducts to keep them open.
   This stent supports the ducts to remain open throughout the healing process.
4. Completion of the Procedure: After the root canal is completed, the endoscope is removed and the procedure is over.
   The silicone tubes are removed by the doctor after a few weeks or months.

Postoperative Recovery Process

The recovery period after endoscopic DCR surgery is usually comfortable and patients can return to their daily lives in a short time.
Points to be considered:

• Swelling and Discomfort: There may be mild swelling, discomfort and nasal congestion in the nose after surgery.
  These effects subside within a few days.
• Nose Cleaning: Care should be taken to clean the nose in the postoperative period.
  Nasal wash solutions recommended by the doctor can be used.
• Medication Use: Antibiotics and anti-inflammatory drugs may be used to prevent infection during the healing process.
• Stent Maintenance: The silicone stent placed in the canal should be kept in place.
  Removal of the stents is performed by the doctor after the healing process is complete.

Risks and Side Effects

Although endoscopic DCR surgery is a minimally invasive procedure, it can carry some risks and side effects:

• Infection: There is a risk of infection after surgery, so the doctor’s care instructions should be followed.
• Bleeding Nosebleeds can be seen in rare cases.
• Recurrent blockage: In rare cases, the tear duct may become blocked again after surgery.