About the Procedure
Tears normally drain from the surface of the eye into the nose through a small system of channels. Endoscopic dacryocystorhinostomy, or DCR, creates a new drainage opening between the tear sac (lacrimal sac) and the inside of the nose for selected tear-duct blockages, bypassing the obstruction so tears can drain again.
Getting the diagnosis right matters, because watery eyes can also come from eyelid problems, irritation of the eye surface, a weak tear pump, or blockage higher in the drainage channels — problems that DCR will not fix. DCR can be performed endoscopically through the nostril, an approach that generally avoids a skin incision, or through a small external incision near the side of the nose.
At Norelle Health, DCR is planned together with oculoplastics or ophthalmology. Evaluation confirms where the blockage is and rules out other causes of watering so that the right procedure is chosen for each person.
What this evaluation should clarify
This page is meant to help you understand a few key decisions before considering DCR:
- Whether the cause of watering is confirmed and the level of any blockage is established with the right examination and testing
- How DCR compares with observation, treatment of an eyelid or eye-surface problem, stenting, or another lacrimal procedure
- Which factors — your anatomy, prior surgery, infection history, and the balance of benefits, risks, and recovery — change the recommendation
Considering dacryocystorhinostomy (DCR)? The next step is a quiet, unhurried conversation.
Evaluation and treatment pathway
- Confirm the diagnosis, the goal of treatment, and the reasons a less invasive or nonsurgical approach is not enough.
- Candidacy includes a tear-drainage evaluation and a nasal examination, with irrigation, probing, imaging, or other testing chosen according to the level of obstruction, infection history, prior surgery, and any suspected mass.
- Alternatives include observation, treatment of an eye-surface or eyelid problem, stenting or other lacrimal procedures, external DCR, and treatment of infection or a tumor, depending on the cause and level of blockage.
- Through the nose, the bone over the tear sac is opened and a new drainage opening (ostium) is created; a soft stent may be used in selected cases. The ENT and ophthalmic roles, the stent plan, and any nasal procedures are explained.
- Tearing, nasal congestion, minor bleeding, and stent awareness can occur. Follow-up checks healing of the new opening, tear drainage, infection, and scarring, with instructions individualized by both teams.
Tear drainage anatomy
Tears wash across the eye and drain through small openings at the inner corners of the eyelids called puncta. From there, they pass through short channels into the tear sac (lacrimal sac), then down a duct that empties into the nose.
A blockage anywhere along this path can cause tears to overflow. DCR specifically addresses blockages at or below the tear sac by creating a new opening directly from the sac into the nose.
Symptoms of blocked tear duct
A blocked tear duct often causes:
- Constant watering or tears running down the cheek
- Crusting or discharge at the inner corner of the eye
- Recurrent infection or swelling of the tear sac (dacryocystitis)
- A feeling of pressure or a tender lump near the inner corner of the eye
Watering can also come from other causes, such as eye-surface irritation or eyelid position problems, which is why evaluation is important before surgery.
Endoscopic versus external DCR
In endoscopic DCR, the surgeon works through the nostril using an endoscope to create the new drainage opening from inside the nose, an approach that generally avoids an external incision or skin scar. In external DCR, a small incision is made near the side of the nose to reach the tear sac.
Both approaches aim to create a durable opening between the tear sac and the nose. The choice depends on the cause and location of the blockage, prior surgery, and individual anatomy, and is discussed before the procedure.
Stents and postoperative care
A soft, temporary stent (a thin silicone tube) is often placed through the tear drainage system to keep the new pathway open while it heals. It usually is not visible in normal activity and is removed in the office weeks to months later.
Afterward, nasal care with saline rinses supports healing, and nose blowing and straining are typically limited for a short period. Eye drops or ointment may be prescribed. Specific instructions depend on whether an endoscopic or external approach was used.
Persistent tearing and revision
Most people have improved tear drainage after DCR, but the new opening can sometimes scar or narrow, and tearing can persist or return. When this happens, additional treatment or a revision procedure may be considered.
Follow-up checks that the opening remains open and that tears are draining as expected. Ongoing watering is evaluated to determine whether it is from the drainage pathway or another cause.
What to bring to your consultation
Bringing the right records helps make the most of your visit. Where possible, bring or securely transfer:
- Imaging files and reports, if any have been done
- Any prior endoscopy or operative findings
- Pathology results, if relevant
- Relevant laboratory results
- Notes from prior treatment and a current medication list
- The specific question you would most like answered
For lacrimal care, your records may be reviewed with the specialists involved in that part of your evaluation.
When to seek urgent care
Some symptoms need prompt or emergency assessment rather than a routine appointment. Seek care for severe eye pain, a change in vision, rapidly increasing redness or swelling, a high fever, heavy bleeding, or difficulty breathing.
Rapidly increasing pain, swelling, redness, or fever around the eye can signal a spreading infection. An online form or routine appointment request is not an emergency service.
Medical review
This page is a patient-education resource reviewed by the responsible Norelle Health clinician before publication. It does not replace an in-person evaluation. Rapidly increasing pain, swelling, redness, or fever around the eye can signal a spreading infection and should prompt urgent medical care.
Specialists who perform dacryocystorhinostomy (DCR)
Dr. Adrian Ong
MD
Board-Certified Facial Plastic & Reconstructive and Head & Neck Surgeon
Dr. Adrian Ong is a board-certified surgeon who practices exclusively on the face, head, and neck, with expertise spanning rhinoplasty, sinus surgery, facial trauma, reconstruction, and sleep surgery.
- Functional and aesthetic rhinoplasty (including revision)
- Sinus surgery and complex revision sinus surgery
- Facial trauma and nasal fractures
- Head and neck cancer surgery and microvascular reconstruction
Also caring for this area
Not sure who to see? Our patient coordination team can help match you with the right specialist.
(212) 444-8006Frequently Asked Questions
Candidacy is based on a tear-drainage evaluation and a nasal examination, with irrigation, probing, imaging, or other testing chosen according to the level of obstruction, infection history, prior surgery, and any suspected mass.
Through the nose, the bone over the tear sac is opened and a new drainage opening is created; a soft stent may be used in selected cases. The ENT and ophthalmic roles, the stent plan, and any nasal procedures are explained beforehand.
Alternatives include observation, treatment of an eye-surface or eyelid problem, stenting or other lacrimal procedures, external DCR, and treatment of infection or a tumor, depending on the cause and level of blockage.
Patients may have tearing, nasal congestion, minor bleeding, and stent awareness. Follow-up assesses healing of the new opening, tear drainage, infection, and scarring, with instructions individualized by both teams.
Clinical References
These independent resources from medical and professional organizations offer further reading. They are provided for general education and do not replace a consultation with a clinician.
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