What causes a watery eye?
A watery eye can be due to many causes, but it is essentially an imbalance between the number of tears being produced by the tear gland and the amount that can be removed by evaporation and the tear drainage system. Problems with the eyelid or narrowing of the drainage canals can prevent tears being drained into the nose. Some people have more than one factor causing their watering. Some people with dry eyes may even experience watering due to reflex tearing as the eye attempts to keep itself moist.
How successful is the surgery?
In most cases where the obstruction of the tear duct is in the nose, there is a 90% success rate. This means 1 in 10 people may not improve after surgery. Rarely if the obstruction is in the tiny tear canals on the eyelid, the success rate is less and can vary between 50-90% depending on the extent of blockage.
What type of anaesthetic is necessary?
The operation takes about 60 minutes and is usually performed under a local anaesthetic with intravenous sedation to make you sleepy, so you do not feel any discomfort.
What should I do in preparation for surgery?
Blood thinning medications such as aspirin, clopidogrel, Rivaroxaban and warfarin can make bleeding more likely during and after surgery. If you are taking these drugs your doctor will tell you if and when to stop these medications prior to surgery. You should also stop anti-inflammatory drugs like ibuprofen (Nurofen), fish oil, ginger, ginseng and garlic containing supplements 2 weeks before surgery.
You will need to fast – no FOOD from midnight and then CLEAR fluids only (water/cordial or black tea/coffee – no milk,) up to two hours before admission.
Is there anything I should not do after the operation?
After your operation, have a quiet evening and avoid strenuous exercise, running or heavy lifting (>5kg) for a week.
You cannot drive, operate machinery, drink alcohol or take sedative drugs for the first 24 hours. Do not blow your nose for 2 weeks as this may cause bleeding.
You may wipe your nose or gently sniff to clear it. If you sneeze, try to keep your mouth open.
Very hot food and drink should be avoided for 24 hours after the operation as they can increase the risk of bleeding.
We recommend trying to sleep upright for the first 24 hours after surgery.
What happens after surgery?
After the operation you will have some bright blood/pinkish discharge ooze from the nose. This usually stops within a few days. If there is bleeding sit forward and apply an ice pack to the bridge of your nose for 15 minutes by the clock without releasing.
You may also suck on an ice cube as this may help reduce the bleeding. Wipe away any bleeding with a clean tissue/towel. Spit out any blood into a bowl on your lap.
Repeat for another 15 minutes. If the bleeding is severe or continues for more than half an hour, please attend your nearest accident and emergency department.
There is usually no significant pain after the surgery. You may note some aching, tenderness, swelling and bruising on the side of the nose and around the eye. If you experience pain take paracetamol (not aspirin or ibuprofen for two weeks as this could cause bleeding).
If you wear glasses, you may find that it is a little tender where the glasses rest on the nose and you may need to rest your glasses a little further down the nose for the first few weeks.
Your nose will feel blocked for about a week, however, remember you are not allowed to blow your nose.
You may drive after 24 hours and most people require a week off work.
Do not travel on an airplane for 2 weeks following surgery.
Do not be discouraged if your eye is still watery after surgery. It is usual to have a watery eye for some weeks or even months after surgery, until the swelling and inflammation has settled.
When you do start to blow your nose after 2 weeks, you may notice a slight puff of air over the eye. This occurs in many patients after successful surgery and is a sign that the new drainage passage is open.
If you have had tubes inserted at the time of surgery, they are often just visible in the corner of the eye between the two eyelids. The tubes will be removed at your appointment 6-12 weeks after surgery. They are tied inside the nose and a loop can occasionally protrude from the inner corner of the eyelids. If this happens do not be alarmed: if you are able to gently push the tubes in again then do so. Otherwise make an appointment to be seen at the clinic so they can be repositioned or removed. If the loop is large it can be taped to the side of the nose or onto the cheek until you see the doctor, so it does not prevent blinking.
What are the main complications following a DCR?
Bleeding: A nosebleed can occur up to 14 days after surgery. This happens to about 1 in 100 patients. In most cases the bleeding will stop by itself or with icepacks, but if it continues or is very heavy you should attend the accident and emergency department at your nearest hospital.
Infection: Infection of the wound or sinuses may rarely occur in 1 in a 100 people usually within the first week and is treated with oral antibiotics. If you develop a temperature or increased nasal or facial pain, then seek medical advice.
Failure of the watery eye to improve: This occurs in 1 in 10 people and can sometimes be improved with a second operation.
Scarring: this is normally hidden in the natural skin crease of the nose. The scar may seem a bit thickened & red for 6 to 12 weeks, becoming almost invisible after that period. Not every scar heals equally well. A thickened or reddened scar can be improved with silicone scar remodelling gel, but the treatment needs to be continued for months to have a good result.
Other rare complications include; nasal deformity, infection, cerebrospinal fluid leakage and alteration of sense of smell.
What is the follow-up treatment?
You will be given an appointment 6 weeks after surgery to check if the new drainage pathway is open.