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What Is Lacrimal Surgery (Dacryocystorhinostomy)?

Dacryocystorhinostomy is a lacrimal surgery that reroutes tear drainage by creating a new connection between the lacrimal sac and the nasal cavity. It is commonly used to treat symptomatic nasolacrimal duct obstruction that causes chronic tearing and mucus retention. The new opening bypasses the blocked duct so tears can drain more freely. Dacryocystorhinostomy can be performed through an external skin incision or endoscopically through the nose.

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What Is Lacrimal Surgery (Dacryocystorhinostomy)?

Dacryocystorhinostomy is a lacrimal surgery that reroutes tear drainage by creating a new connection between the lacrimal sac and the nasal cavity. It is commonly used to treat symptomatic nasolacrimal duct obstruction that causes chronic tearing and mucus retention. The new opening bypasses the blocked duct so tears can drain more freely. Dacryocystorhinostomy can be performed through an external skin incision or endoscopically through the nose.

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Why Dacryocystorhinostomy Is Done

This procedure is usually recommended when a blocked nasolacrimal duct causes persistent epiphora and does not respond to simpler measures. It can also help prevent repeated infections of the lacrimal sac, called dacryocystitis, by reducing fluid and mucus buildup. Before surgery, clinicians confirm the level of obstruction with examination and irrigation testing. Treating eyelid malposition or ocular surface irritation is also important because these can mimic tearing from obstruction.

External vs Endoscopic Approaches

Both approaches aim to create a durable opening from the lacrimal sac into the nose.

  • External dacryocystorhinostomy uses a small incision near the inner corner and allows direct access to the sac.
  • Endoscopic dacryocystorhinostomy is performed through the nostril and avoids a skin incision.
  • Some surgeons place a temporary silicone stent to support healing, depending on anatomy and risk factors.

What to Expect During Recovery

Recovery usually includes antibiotic and anti-inflammatory eye drops and instructions to protect the surgical site. Mild swelling, bruising, and nasal congestion can occur early. Saline nasal rinses may be recommended in endoscopic cases, and patients are often advised to avoid heavy nose blowing for a short period. Follow-up visits check wound healing, stent position if used, and whether tearing has improved.

Risks and When to Seek Care

Like any procedure, dacryocystorhinostomy has potential risks.

  • Bleeding, infection, or scarring
  • Granulation tissue or closure of the new opening, leading to persistent tearing
  • Stent irritation or displacement if a tube is placed

Seek prompt care for increasing pain, fever, worsening swelling near the inner corner, heavy nasal bleeding, or sudden vision changes.

FAQs on Dacryocystorhinostomy

Is dacryocystorhinostomy the same as tear duct surgery?

Yes. Dacryocystorhinostomy is commonly called tear duct surgery because it creates a new tear drainage pathway into the nose.

Will dacryocystorhinostomy leave a scar?

External dacryocystorhinostomy uses a small incision that often heals with a subtle scar. Endoscopic dacryocystorhinostomy is performed through the nose and does not create a skin scar.

Can tearing come back after surgery?

Yes. The new opening can narrow or close, or there may be additional blockage elsewhere in the drainage system. Follow-up and treatment of contributing nasal or eyelid factors can improve long-term results.

Do you always need a silicone stent?

No. Some surgeons use stents routinely, while others reserve them for specific situations such as canalicular narrowing or higher risk of scarring. Your surgeon will explain what is appropriate for your anatomy.

References

Dacryocystorhinostomy. StatPearls - NCBI Bookshelf (National Library of Medicine, National Institutes of Health). https://www.ncbi.nlm.nih.gov/books/NBK557851/. Date Accessed February 5, 2026.

Blocked Tear Duct (Nasolacrimal Duct Obstruction). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17260-blocked-tear-duct-nasolacrimal-duct-obstruction. Date Accessed February 5, 2026.

Blocked tear duct - Diagnosis & treatment. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/blocked-tear-duct/diagnosis-treatment/drc-20351375. Date Accessed February 5, 2026.

A critical update on endoscopic dacryocystorhinostomy. PubMed Central (National Library of Medicine, National Institutes of Health). https://pmc.ncbi.nlm.nih.gov/articles/PMC11706521/. Date Accessed February 5, 2026.

Success and complications of endoscopic laser dacryocystorhinostomy vs external dacryocystorhinostomy: A systematic review and meta-analysis. Pakistan Armed Forces Medical Journal. https://www.pafmj.org/PAFMJ/article/view/12429. Date Accessed February 5, 2026.