Most of the literature published on tear drain surgery (DCR; Dacryocystorhinostomy) supports a higher success rate when the surgery is performed from the outside, rather than from inside the nose. This is probably partly due to the fact that non-ophthalmologists are more likely to do the surgery from inside the nose, if that is a region where they typically operate. The problem is, non-ophthalmologists are less likely to be able to locate the site of the tear drain problem preoperatively, and therefore they may be doing internal surgery when it is not appropriate.
I generally perform the incisional surgery, with a small skin incision in the thin skin of the eyelid. This allows me to perform a more aggressive bony removal when reconstructing the new tear drain, which I think is probably the most important element of a successful DCR surgery.
Worried about the incision? Don’t be — take a look at the typical incisional “scar” after 3 weeks:
Pretty tough to spot? They key is to place the incision in the thin skin of the eyelid, not the thicker skin along the nasal sidewall, and to close it meticulously. The rule is that it heals invisibly. By the way, if you look closely, you can see the little silicone tube running between the upper and lower eyelids on the inside corner — that tube keeps the new tear drain open while it’s healing.
Spot the DCR scar (one month postoperative, a happy patient with no tearing, no discomfort, and no scar):
(By the way, this kind lady was so pleased with her surgery that she said I could direct patients to call her and learn all about it…)