Dacryocystorhinostomy

The most frequent cause of contant eye watering in a patient is the obstruction of the bottom of the tear duct. The tear duct is the "drain" through which the tear moves from the eye to the nasal cavity. When the end of this passage is blocked (usually the most common part to be blocked) a procedure that reroutes the passage is performed. This surgical procedure is called dacryocystorhinostomy​​.​​​​​

Surgery is the solution to the constant and irritating eye watering that causes obstruction of the tear duct. Patients can benefit from rerouting their duct in a dacryocystorhinostomy, meaning they will stop having epiphora (constant eye watering) and the irritations arising from it.

In those cases where, in addition, common infections of the lacrimal sac (dacryocystitis) occur, surgery is the only possible solution to repeated infections. 

Dacryocystorhinostomy surgery is a bypass procedure. It can be performed in three different ways, depending on the access and technology used. Each technique has its pros and cons, and these should be weighed up in each individual case. 

It is a very simple procedure with minimum physical and postoperative repercussions, although it should be very carefully assessed because of its obvious limitations which we have already mentioned.  

A classic dacryocystorhinostomy can be performed externally by making a small, unnoticeable incision in the skin, or endonasally through the nose on the same side as the affected eye.  

In cases where laser surgery is feasible, this seems to be the best option. It is a very quick, clean and safe procedure, with no need for skin incisions. There is practically no postoperative inflammation. 

However, despite all these plus points, it is important to note its low success rate. According to all the studies carried out to date, the success rate of laser dacryocystorhinostomy does not exceed 60%, which makes it the dacryocystorhinostomy procedure with the lowest rate of success.

The external dacryocystorhinostomy procedure is the most classic procedure and continues to be the most commonly used. Despite being performed via a cutaneous incision, its high rate of success means its the most commonly used, as practically 90% obtains the desired result even in studies performed over a longer term. Assessing which is best for each case must be agreed on using clearly detailed information that has been properly understood by the patient.

The dacryocystorhinostomy procedure has received much bad press for many years due to its bleeding complications. The aim of this surgery is to access the nose via an osteotomy (route through the nose), a procedure in which sutures cannot be used.

In some cases, this may lead to the possibility of significant postoperative bleeding which can be annoying. Despite the potential for this, which does occur but is very infrequent, the complications of the dacryocystorhinostomy procedure are actually few and manageable.