‘น้ำตาไหลเรื้อรัง’ แก้ด้วยการผ่าตัด Dacryocystorhinostomy (DCR) ทางออกที่ช่วยให้ดวงตากลับมาสดใสอีกครั้ง!

Dacryocystorhinostomy (DCR) surgery is a medical procedure designed to treat blocked tear ducts, which is the main cause of chronic tearing, watery eyes, and infections in the lacrimal sac area.
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This surgery creates a new drainage pathway directly between the lacrimal sac and the nasal cavity, allowing tears to flow normally, reducing stagnation and the risk of infection.
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<h2>Basic Knowledge about Tear Ducts and DCR Surgery to Create a New Tear Drainage Pathway</h2>
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Our tears are continuously produced by the lacrimal glands and drain through small openings at the edges of the upper and lower eyelids into small canals (Lacrimal canaliculi), which merge into a larger duct leading to the lacrimal sac, then flow through the tear duct into the nasal cavity.
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If this part of the tear duct is blocked, tears cannot drain out, causing constant tearing or infections.
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DCR surgery involves creating a new passage through the bone beside the nasal cavity, connecting the lacrimal sac directly to the nasal cavity, bypassing the blockage, and improving tear drainage.
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<h2>Criteria for Patients Suitable for DCR Surgery</h2>
<ul>
<li style="font-weight: 500">Patients with a clear diagnosis of ‘tear duct obstruction’ causing chronic tearing that cannot drain normally</li>
<li style="font-weight: 500">Experiencing excessive tearing (constant tearing) that interferes with daily life</li>
<li style="font-weight: 500">Having chronic lacrimal sac infections such as swelling, redness, pain, or pus</li>
<li style="font-weight: 500">Being in good enough health to undergo general anesthesia and surgery</li>
</ul>
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<h2>Detailed Steps of DCR Surgery</h2>
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<ol>
<li>External DCR Surgery</li>
</ol>
<ul>
<li style="font-weight: 500">The doctor makes a small incision on the skin under the eye near the nasal bridge (about 1 centimeter long)</li>
<li style="font-weight: 500">Opens part of the bone beside the nasal cavity to create a new tear drainage channel</li>
<li style="font-weight: 500">Connects the lacrimal sac directly to the nasal cavity</li>
<li style="font-weight: 500">May insert a small silicone tube to keep the new passage open during recovery</li>
<li style="font-weight: 500">Closes the wound with either dissolvable or removable stitches</li>
</ul>
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<ol start="2">
<li>Endoscopic DCR Surgery</li>
</ol>
<ul>
<li style="font-weight: 500">Uses a small endoscope inserted through the nostril without external skin incisions</li>
<li style="font-weight: 500">Accesses the nasal cavity to open the bone and connect the lacrimal sac to the nasal cavity</li>
<li style="font-weight: 500">Inserts tubes or materials to keep the passage open, similar to the external method</li>
<li style="font-weight: 500">No external scars or cuts, with faster recovery</li>
</ul>
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<table>
<tbody>
<tr>
<td>Comparison Topic</td>
<td>External DCR Surgery</td>
<td>Endoscopic DCR Surgery</td>
</tr>
<tr>
<td>Surgical Method</td>
<td>Small incision beside the nasal bridge</td>
<td>Uses an endoscope through the nostril, no skin incision</td>
</tr>
<tr>
<td>Creation of Tear Drainage Channel</td>
<td>Opens a passage from the lacrimal sac to the nasal cavity</td>
<td>Creates a new passage between the lacrimal sac and nasal cavity from inside</td>
</tr>
<tr>
<td>Surgical Wound</td>
<td>Small skin wound</td>
<td>No external wound (no facial scar)</td>
</tr>
<tr>
<td>Clarity of Structural View</td>
<td>Clear view of structures, easier to operate</td>
<td>Requires specialized skills and equipment</td>
</tr>
<tr>
<td>Recovery Time</td>
<td>Quick recovery</td>
<td>Faster recovery, no scarring</td>
</tr>
<tr>
<td>Complexity and Difficulty</td>
<td>Relatively simple, with extensive experience</td>
<td>Requires specialized expertise, equipment, and general anesthesia</td>
</tr>
<tr>
<td>Success Rate</td>
<td>Over 90%</td>
<td>Between 80-90%, depending on surgeon’s expertise</td>
</tr>
<tr>
<td>Complications</td>
<td>Some risk of scarring and wound infection</td>
<td>May have longer swelling and slightly more bleeding</td>
</tr>
<tr>
<td>Hospital Stay</td>
<td>Usually no overnight stay, can go home the same day</td>
<td>Requires at least one night in hospital</td>
</tr>
<tr>
<td>Suitable For</td>
<td>Elderly, patients with chronic diseases, or those with previous surgery blockage or facial injury</td>
<td>Those who want no scars and are ready for general anesthesia</td>
</tr>
<tr>
<td>Cost</td>
<td>Lower than endoscopic surgery</td>
<td>Higher due to advanced equipment and specialist surgeons</td>
</tr>
</tbody>
</table>
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<h2>Preparation Before DCR Surgery</h2>
<ul>
<li style="font-weight: 500">Avoid food and drink for at least 6-8 hours before surgery to prevent aspiration during anesthesia</li>
<li style="font-weight: 500">Take a shower and wash hair thoroughly, trim fingernails and toenails short, do not wear nail polish or makeup</li>
<li style="font-weight: 500">Men should shave facial hair in the surgical area to prevent infection</li>
<li style="font-weight: 500">Do not wear any jewelry, and remove contact lenses, dentures, or any accessories before entering the operating room</li>
<li style="font-weight: 500">Inform the doctor about medication history, chronic diseases such as hypertension, diabetes, or heart disease, including blood thinners like aspirin, so the doctor can plan treatment</li>
<li style="font-weight: 500">Undergo physical examination and health assessment by the doctor to evaluate readiness for anesthesia</li>
<li style="font-weight: 500">Prepare mentally and get enough rest the night before surgery</li>
<li style="font-weight: 500">Come with a relative or caregiver for safety and convenience in transportation</li>
<li style="font-weight: 500">Sign the consent form after receiving explanation about the procedure, side effects, and precautions</li>
</ul>
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Good preparation helps reduce the risk of complications and increases the chances of successful surgery with fast and safe recovery.
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<h2>Recovery and Postoperative Care</h2>
<ul>
<li style="font-weight: 500">There may be blood or blood-tinged mucus from the nose for the first 1-2 days</li>
<li style="font-weight: 500">Use antibiotic eye drops as prescribed to prevent infection</li>
<li style="font-weight: 500">Avoid forceful nose blowing or prolonged head bending</li>
<li style="font-weight: 500">Follow-up appointments to check the wound and tear duct function, such as tear duct irrigation</li>
<li style="font-weight: 500">Typically recover within 1-2 weeks and can return to normal daily activities</li>
</ul>
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<h2>Possible Complications</h2>
<ul>
<li style="font-weight: 500">Excessive bleeding or bruising after surgery</li>
<li style="font-weight: 500">Wound infection or inflammation</li>
<li style="font-weight: 500">Tear drainage channel closing again after repeat surgery or keloid formation</li>
<li style="font-weight: 500">Scarring (only in external surgery)</li>
</ul>
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In summary, DCR surgery is a standard, effective, and safe method that helps restore normal tear drainage and improves patients’ quality of life.
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The doctor will choose the surgical technique suitable for each case, and if patients follow postoperative instructions correctly, it will increase the chances of successful treatment and reduce the risk of complications.
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Those with chronic tearing due to tear duct obstruction should see an ophthalmologist for evaluation and to plan the most appropriate treatment for themselves.

Diaphragmatic tear duct surgery (DCR) is a solution for “blocked tear ducts” that cause unrelenting tears and infection. The surgery creates a new tear drainage channel between the lacrimal sac and the nasal cavity, restoring bright, dry eyes and reducing the chance of re-infection.

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'Chronic tearing' can be treated with Dacryocystorhinostomy (DCR) surgery, a solution that helps restore bright eyes!

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