68720 Dacryocystorhinostomy (fistulization of lacrimal sac to nasal cavity)

Name of the Procedure:

Dacryocystorhinostomy (DCR)

Summary

Dacryocystorhinostomy (DCR) is a surgical procedure to create a new drainage pathway between the lacrimal sac (part of the tear drainage system) and the nasal cavity. This helps to bypass a blockage in the tear duct, allowing tears to drain properly.

Purpose

DCR addresses tear duct blockages that cause excessive tearing (epiphora) and recurrent eye infections. The goal is to restore normal tear drainage and alleviate symptoms like eye watering and discomfort.

Indications

• Chronic tearing (epiphora)
• Recurrent dacryocystitis (infection of the lacrimal sac)
• Nasolacrimal duct obstruction that doesn’t respond to less invasive treatments

Preparation

• Patients may need to fast for several hours before the procedure if general anesthesia is used.
• Blood tests and imaging studies (e.g., CT scan) may be conducted to evaluate the tear drainage system.
• Patients should inform their doctor of any medications they are taking, as some may need to be adjusted.

Procedure Description

1. The patient is positioned, and anesthesia is administered (local or general).
2. A small incision is made near the inner corner of the eye or inside the nasal cavity.
3. The surgeon creates an opening between the lacrimal sac and the nasal cavity.
4. A stent or tube may be inserted to keep the new drainage pathway open during healing.
5. The incision is closed with sutures if needed.
6. Nasal packing might be placed to control bleeding.

Duration

The procedure typically takes 30 minutes to 1 hour.

Setting

DCR is usually performed in a hospital or an outpatient surgical center.

Personnel

• Ophthalmologist or oculoplastic surgeon
• Anesthesiologist (if general anesthesia is used)
• Surgical nurse

Risks and Complications

• Bleeding
• Infection
• Scarring
• Failure of the new drainage pathway to remain open
• Adverse reactions to anesthesia

Benefits

• Relief from excessive tearing and eye infections
• Improved comfort and quality of life
• Restoration of normal tear drainage

Benefits are typically noticeable within a few weeks after the procedure.

Recovery

• Patients may experience swelling, bruising, and discomfort around the eye.
• Pain management includes prescribed medications.
• Follow-up appointments are crucial to monitor healing.
• Avoid strenuous activities and swimming for several weeks.
• Nasal packing is usually removed a few days after surgery, and stents are removed after several weeks.

Alternatives

• Tear duct probing: Less invasive but often less effective for chronic issues.
• Balloon dacryoplasty: A procedure to widen the tear duct using a balloon catheter.
• Eye drops or medications to manage symptoms without surgery.

Each alternative has its own pros and cons, with varying degrees of effectiveness and invasiveness.

Patient Experience

Patients might feel some discomfort and swelling post-surgery. Pain is generally manageable with medication. Most patients can return to normal activities within a week or two, although complete recovery might take a few weeks. It's important to follow all post-operative care instructions to ensure the best outcome.