Before your doctor decides that a dacrycocystorhinostomy is the best option for your condition, there are a number of eye-related exams that can be carried out, including probing and irrigation of the tear system and the use of dye in the tears to observe how long it takes for the eye to clear it.

Specific preparation for the procedure will depend on the type of anesthesia used. If general anesthesia is used, you may need to undergo a physical examination, blood tests, chest x-ray, and an electrocardiogram (EKG). You will also need to avoid food and water for six to eight hours before the procedure or as recommended by the doctor.

There are two types of procedure:

1.    Traditionally, a dacrycocystorhinostomy is performed with an incision in the skin on the side of the nose, close to the eye. Some bone is removed so a tube can be inserted through the lacrimal sac and into the nose. This tube is then left in place to prevent the gap from closing and is removed after a few months.

2.    Endoscopic dacrycocystorhinostomy, a thin, flexible tube (endoscope) is inserted into the nose along with surgical instruments. An opening is then made in the lacrimal sac from inside the nose, avoiding external scarring. In some cases, a stent may be used for a period of time to maintain the opening.

If general anesthesia was used, you will need to be observed in a recovery area for a couple of hours after the procedure, until the anesthesia wears off. You will likely be able to go home the same day. You will be given medication to manage pain as well as prevent infection (oral or topical for the eye). Please keep all scheduled follow-up visits with your doctor. If a stent was placed, you will be scheduled to have it removed as determined appropriate by your doctor.

Complications are fairly uncommon with an endoscopic dacrycocystorhinostomy, but may include:

• Pain, which is usually well controlled with medication.
• Infection.
• Bleeding.
• Scarring within the nose, leading to blockage of the opening and recurrence of excessive tearing.
• Extremely rare is the risk of bleeding within the orbital cavity or injury to the eye.
• Reaction to general anesthesia.

Before the Procedure

• Please plan to stay in Thailand for at least one week through the duration of treatment.
• It is recommended that you stay in a hotel close to the hospital for convenience in traveling to the hospital before and after the procedure.
• You will undergo a health screening when convenient for you before the procedure as the procedure is done using general anesthesia. You will likely need to fast before the health screening. You will be given detailed instructions by your medical team.

After the Procedure

• The doctor will schedule a follow-up appointment for the day after the procedure.
• If you have no abnormal symptoms after the procedure, you can usually return to your home country. The final decision will depend on your doctor’s recommendation.
• After the follow-up appointment the day after the procedure, you will need to see your doctor one month after the procedure, three months after the procedure, and six months after the procedure. If you cannot return to Thailand for these appointments, please see an ophthalmologist in your home country.

The success of the procedure depends on the blockage of the nasolacrimal duct. Your doctor will investigate and explain this to you.

What if the procedure is not done?

Excessive tearing can impair vision and a blocked nasolacrimal duct can lead to infections of the eye.