Dacryocystorhinostomy (DCR)
What is Dacryocystorhinostomy (DCR) ?
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Why do you need DCR ?
DCR is indicated for:
- Nasolacrimal duct obstruction (NLDO):
- Chronic epiphora: Persistent tearing due to blocked tear drainage.
- Recurrent infections: Dacryocystitis (tear sac infection) causing pain, swelling, or discharge.
- Congenital or acquired causes:
- Congenital: Blockage present at birth (common in infants, but most resolve by 1 year).
- Acquired: Aging, trauma, sinusitis, nasal polyps, or tumors obstructing the duct.
- Failed conservative treatments:
- Probing or irrigation ineffective in adults (probing may work in infants <1 year).
- Secondary causes:
- Post-trauma: Scarring from facial fractures.
- Tumors: Obstructing the duct (rare, requires biopsy).
The procedure aims to bypass the blocked nasolacrimal duct by creating a new drainage pathway between the lacrimal sac and nasal cavity, relieving tearing and preventing infections.
Why Do DCR Costs Vary in Philippines?
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DCR Procedure
- Before Surgery Evaluation:
- Diagnosis:
- Dye disappearance test: Fluorescein dye applied to the eye; delayed clearance indicates blockage.
- Lacrimal irrigation: Saline flushed through the tear duct; reflux confirms obstruction.
- Dacryocystogram (DCG): X-ray with contrast to locate the blockage (rarely needed).
- Nasal endoscopy: Rules out nasal pathology (e.g., polyps, deviated septum).
- Blood tests: Blood sugar, clotting profile (esp. for external DCR).
- Medications: Stop blood thinners (e.g., aspirin) 5–7 days prior if safe; antibiotic eye drops (e.g., moxifloxacin) 1–2 days pre-surgery.
- Consent: Risks, including scarring (external DCR), are explained.
- Diagnosis:
- Surgical Techniques:
- External DCR:
- Performed under general or local anesthesia with sedation, lasting 45–90 minutes.
- A small incision (10–15 mm) is made on the side of the nose near the tear sac.
- Bone between the lacrimal sac and nasal cavity is removed (osteotomy) to create a new drainage pathway.
- The lacrimal sac is opened and sutured to the nasal mucosa, forming a permanent fistula.
- Silicone tubes (stents) may be placed to maintain patency (removed after 6–12 weeks).
- The skin incision is closed with sutures (removed after 7–10 days).
- Endoscopic DCR:
- Minimally invasive, lasting 30–60 minutes, under general anesthesia.
- No external incision; performed through the nasal cavity using an endoscope.
- Bone is removed using specialized instruments to create a drainage pathway.
- Silicone stents may be placed (removed after 6–12 weeks).
- Preferred for no visible scar; requires ENT expertise.
- Intraoperative Tools:
- Endoscope: Visualizes nasal anatomy (endoscopic DCR).
- Osteotome/drill: Removes bone for the new pathway.
- Silicone stents: Maintains drainage patency.
- External DCR:
- After Surgery:
- Observation: Same-day discharge (endoscopic); 1-day stay (external, if under general anesthesia).
- Nasal care: Saline nasal spray to prevent crusting; avoid nose blowing for 1–2 weeks.
- Eye care: Antibiotic/steroid drops (e.g., tobramycin-dexamethasone) for 2–4 weeks.
- Pain management: Mild pain managed with acetaminophen.
- Instructions: Avoid strenuous activity or swimming for 2 weeks; keep the incision dry (external DCR).
Recovery After DCR
- Hospital Stay: Same-day discharge (endoscopic); 1-day stay (external, if under general anesthesia).
- Post-Surgery Care:
- Swelling/Bruising: Mild swelling around the eye or nose for 3–7 days (external DCR); minimal with endoscopic.
- Pain: Mild discomfort for 2–5 days, managed with acetaminophen.
- Nasal/Eye care: Saline nasal spray 2–3 times daily for 2 weeks; antibiotic/steroid eye drops for 2–4 weeks.
- Activity: Avoid strenuous activity, nose blowing, or swimming for 2 weeks; normal activities (e.g., reading) within 2–3 days.
- Bleeding: Mild nasal oozing for 1–2 days; heavy nosebleeds are abnormal.
- Stents (if used): Removed after 6–12 weeks (outpatient procedure).
- Follow-Up:
- Visits at 1 week (suture removal for external DCR), 1 month, and 3 months to check patency.
- Lacrimal irrigation: At 1 month to confirm drainage.
Most resume normal activities in 1–2 weeks; full recovery takes 4–6 weeks. Success rate: 90–95% for both external and endoscopic DCR (symptom resolution, patent drainage).
Risks and Complications
- Surgical Risks:
- Bleeding (2–5%): Mild nasal oozing common; rare severe nosebleed may need packing or cauterization.
- Infection (1–3%): Nasal or tear sac; treated with antibiotics.
- Scarring (external DCR, 2–5%): Visible scar on the side of the nose; rare with endoscopic.
- Post-Surgery:
- Failure (5–10%): New pathway closes due to scarring or granulation tissue; may need revision DCR.
- Nasal issues (1–3%): Crusting, sinusitis, or nasal irritation; managed with saline spray or antibiotics.
- Tear drainage issues (1–2%): Persistent epiphora if pathway narrows; may need stent replacement or revision surgery.
- Orbital injury (<1%): Rare; damage to surrounding structures (e.g., medial rectus muscle) causing double vision.
- Long-Term:
- Recurrence (5–10%): Blockage reoccurs; higher with underlying nasal pathology (e.g., polyps).
Report heavy nosebleeds, severe pain, fever, or persistent tearing promptly.
Frequently Asked Questions (FAQs)
What causes a blocked nasolacrimal duct?
Aging, infections (e.g., sinusitis), trauma, nasal polyps, tumors, or congenital factors.
Can I avoid DCR surgery?
Yes, in children <1 year: 90% resolve spontaneously or with probing; adults with mild symptoms may try antibiotics or irrigation, but surgery is needed for persistent obstruction.
Is DCR painful?
No, performed under anesthesia; mild discomfort post-surgery for 2–5 days, managed with medication.
How soon can I resume activities?
Light activities in 2–3 days; normal routines in 1–2 weeks; full recovery in 4–6 weeks.
Is DCR covered by insurance in India?
Yes, for symptomatic NLDO; confirm with your provider.
Signs of complications?
Heavy nosebleeds, severe pain, fever, or persistent tearing.
Will I have a scar after DCR?
External DCR: Small scar on the side of the nose (fades over time); endoscopic DCR: No visible scar.
Lifestyle changes post-surgery?
Avoid nose blowing for 2 weeks, use saline nasal spray, apply prescribed drops, manage nasal conditions (e.g., sinusitis), and attend follow-ups.
Conclusion
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Looking for Best Hospitals for Dacryocystorhinostomy (DCR)
Note: we are not promoting any hospitals
We do not promote any hospitals. All details are sourced from Google and hospital websites. Please verify independently. Start with your surgery—here’s the list of government, budget, and superspecialty hospitals accredited by the Department of Health (DOH), Philippine Health Insurance Corporation (PhilHealth), and Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₱) | Maximum Price (₱) |
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Angeles City |
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Antipolo |
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Bacolod |
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Bacoor |
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Baguio |
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Butuan |
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Cagayan de Oro |
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Caloocan |
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Cebu City |
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Dasmariñas |
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Davao City |
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General Santos |
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General Trias |
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Iligan |
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Iloilo City |
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Las Piñas |
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Makati |
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Malolos |
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Manila |
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Muntinlupa |
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Parañaque |
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Pasay |
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Pasig |
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Puerto Princesa |
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Quezon City |
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San Fernando |
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San Jose del Monte |
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Taguig |
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Valenzuela |
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Zamboanga City |
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Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.
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Looking for Best Hospitals for
Note: we are not promoting any hospitals
We do not promote any hospitals. All details are sourced from Google and hospital websites. Please verify independently. Start with your surgery—here’s the list of government, budget, and superspecialty hospitals accredited by the Department of Health (DOH), Philippine Health Insurance Corporation (PhilHealth), and Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₱) | Maximum Price (₱) |
|---|---|---|
|
Angeles City |
20,000 |
80,000 |
|
Antipolo |
20,000 |
80,000 |
|
Bacolod |
20,000 |
80,000 |
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Bacoor |
20,000 |
60,000 |
|
Baguio |
20,000 |
80,000 |
|
Butuan |
20,000 |
60,000 |
|
Cagayan de Oro |
20,000 |
80,000 |
|
Caloocan |
20,000 |
60,000 |
|
Cebu City |
30,000 |
100,000 |
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Dasmariñas |
20,000 |
60,000 |
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Davao City |
30,000 |
100,000 |
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General Santos |
20,000 |
80,000 |
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General Trias |
20,000 |
60,000 |
|
Iligan |
20,000 |
80,000 |
|
Iloilo City |
20,000 |
80,000 |
|
Las Piñas |
20,000 |
80,000 |
|
Makati |
30,000 |
100,000 |
|
Malolos |
20,000 |
60,000 |
|
Manila |
30,000 |
100,000 |
|
Muntinlupa |
20,000 |
80,000 |
|
Parañaque |
20,000 |
80,000 |
|
Pasay |
20,000 |
80,000 |
|
Pasig |
30,000 |
100,000 |
|
Puerto Princesa |
20,000 |
80,000 |
|
Quezon City |
30,000 |
100,000 |
|
San Fernando |
20,000 |
60,000 |
|
San Jose del Monte |
20,000 |
60,000 |
|
Taguig |
30,000 |
100,000 |
|
Valenzuela |
20,000 |
60,000 |
|
Zamboanga City |
20,000 |
80,000 |
Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.