About the Procedure
Tears normally drain from the surface of the eye into the nose through a small system of channels. When this drainage system becomes blocked, tears back up and cause persistent watering, and the tear sac can become infected. Dacryocystorhinostomy, or DCR, is a procedure that restores tear drainage by creating a new opening between the tear sac and the inside of the nose, bypassing the blockage.
DCR can be performed endoscopically through the nostril, leaving no external scar, or through a small external incision near the side of the nose. Both approaches aim to give tears a reliable path into the nose. The choice depends on the location and cause of the blockage and on individual anatomy.
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.
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.
Considering dacryocystorhinostomy (dcr)? The next step is a quiet, unhurried conversation.
Ophthalmic and nasal evaluation
Evaluation usually involves an eye examination to check the eyelids, puncta, and tear film, and tests to confirm where the drainage system is blocked. Gentle irrigation or probing of the tear ducts may be used to locate the level of obstruction.
The nose is examined, often with an endoscope, to assess the space where the new opening will be made and to identify anything, such as a deviated septum or sinus disease, that could affect the procedure or healing.
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, with no 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.
Considering dacryocystorhinostomy (dcr)? The next step is a quiet, unhurried conversation.
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.
Clinical references
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.
Considering dacryocystorhinostomy (dcr)? The next step is a quiet, unhurried conversation.
Candidacy & Evaluation
Recovery & Aftercare
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
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