I have a blocked tear duct after rhinoplasty that has not resolved. The oculopastic surgeon I've seen has said Iikely can't have an endoscopy procedure as this would cause fibrosis? Also there would still be too much swelling. I am 2 mo postop but I have severe tearing and complete obstruction of the duct which might be severed. I don't want an open procedure as this will leave me with a scar and I feel like I will then have more likelihood of damage to my postop nose. Can any surgeons advise?
I Have to Have a Dacrocystorhinostomy After a Rhinoplasty.
Doctor Answers 4
Endoscopic DCR (tear duct surgery)
Dacryocystorhinostomy (DCR) surgery can be done from external approach or endoscopic (though the nose) approach. They both have equal success (assuming done by experienced surgeons). I perform DCR through the endoscopic approach, 95% of the times. Two main advantages are quicker recovery and lack of external scar. The endoscopic approach won't cause any fibrosis but there is fibrosis present in the nose, it may not possible to do the endoscopic approach DCR. See an oculoplastic surgeon for evaluation.
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Endoscopic DCR after rhinoplasty
I think it is still a bit early to consider any form of a DCR after your rhinoplasty. There is likely still some swelling and it may improve or resolve with more time. See how the pattern of tearing continues for the next several months. Ultimately, if needed, an endoscopic DCR can be done that should not affect the outcome of your rhinplasty results. But I would be hesitant to have this done before six months after surgery.
Endoscopic DCR is an excellent approach in experienced hands. However, your epiphora may subside over time and may not require DCR. Therefore, follow-up with your surgeon and also optain a second opinion.
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Tearing after rhinoplasty
Epiphora, or excessive tearing, can happen after rhinoplasty due to either compression or trauma to the nasolacrimal duct. I guess, first question to answer is whether your epiphora is due to duct discontinuity or just due to swelling. If former, you will need DCR; if latter, maybe wait some more time and see if it gets better. I personally don't think that endoscopic DCR would be a problem 2 months after rhinoplasty. some occuloplastic surgeons are just more comfortable with an open approach, hence maybe their hesitance to do this endoscopically for you. Either consult another occuloplastic surgeon or a facial plastic surgeon who has experience with endoscopic DCRs
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