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Lacrimal Surgery

Lacrimal surgery is performed to repair or reconstruct the tear duct system. The most common indication for this surgery is watering of the eye due to a blocked tear duct. In cases like these, a surgical procedure called dacryocystorhinostomy or (DCR) is performed.  This is usually performed endoscopically with a camera placed in the nasal passage.

Causes of a blocked tear duct

Blocked tear ducts are a result of an inflammation or chronic infection of the eyes or nasal passages and tear drainage system. Your sinuses can aggravate the tissues and form scar tissue which in turn, creates painful swelling. Here are some other causes of a blocked tear duct:

  1. Nasal fractures – which are growths or fleshy swellings that develop in the lining of the nose
  2. Age-related changes such as the narrowing of the openings in the eyelids and the narrowing of the tear drainage tract.
  3. Inflammation or viral infections of the eyes or nose
  4. A tumour along the tear drainage system or in your nose
  5. Diseases of the nasal passages may cause scarring or bone damage near the drainage system

Why will I need a dacryocystorhinostomy?

If your tear ducts are blocked, the procedure will be performed to relieve those symptoms. Symptoms can include excessive watering of the eye or a crusting around it. A dacryocystorhinostomy may be needed if you experience these issues. Other symptoms of an infected duct are:

  1. A mucous discharge
  2. Eye irritation
  3. Tenderness or swelling around the eye

An ophthalmologist will be able to assess your condition and help you decide if this surgery is necessary.

Dacryocystorhinostomy Surgery

If your symptoms are severe, a DCR may be needed. The steps in a DCR procedure will vary depending on the extent of the blockage. Your surgeon may also have certain preferences and experience.

Endoscopic endonasal surgery is performed by using a microscopic camera and other small instruments. These are inserted through the nasal opening to your duct system. It requires no skin incision and leaves no scar on the face

External dacryocystorhinostomy involves your surgeon making an incision on the side of your nose. This is done to by-pass obstruction of the nasolacrimal duct close to the lacrimal sac to re-establish drainage of tears to your nasal cavity.

After your surgery, you will need to use eye drops and a nasal decongestant spray. This is to reduce inflammation and prevent infection. It is advisable to ask your doctor about the benefits and risks of all your treatment options.

Lacrimal Surgery for patients in KZN

Dr. Ladner is an ophthalmologist that practices at Parklands Hospital in Overport, Durban as well as at the Kloof Medical Centre in KZN. He has a special interest in oculoplastic procedures. Should you, or someone you know experience any vision problems, set up an appointment with Dr. Ladner today. Should you or someone you know experience any symptoms of a watery eye, set up an appointment with Dr Ladner today

Lacrimal Surgery FAQs

  • A DCR is a surgical bypass created to restore tear drainage when the natural nasolacrimal duct is permanently blocked. Dr Grant Ladner performs this procedure at our Durban clinics to stop chronic tearing (epiphora) and prevent serious, painful infections of the lacrimal sac.

  • Both techniques have excellent success rates, but Endoscopic DCR offers the advantage of no skin incision or visible scarring. During your consultation in Berea or Kloof, Dr Ladner will use an endoscope to examine your nasal anatomy and determine which approach offers the most reliable long-term result for your specific blockage.

  • Yes, a soft silicone stent (bi-canalicular tube) is standard to keep the new drainage opening from closing during the healing phase. This stent is looped between the corners of your eyelids; it is usually comfortable and will be professionally removed by Dr Ladner in our Durban rooms a few weeks later.

  • With Endoscopic DCR, there is no external scar; with External DCR, the small incision typically fades into a faint, nearly invisible line within a few months. Our surgical techniques focus on aesthetic preservation, ensuring that any external marks are placed within the natural contours of the face.

  • Mild bruising and swelling around the bridge of the nose and lower eyelid are common and typically peak 48 hours after surgery. Most patients find that this "black eye" appearance fades significantly within 7 to 10 days, allowing a comfortable return to social activities.

  • The most critical rule is to avoid blowing your nose for at least 10 days to prevent a nosebleed or "surgical emphysema" (air under the skin). Additionally, you should avoid strenuous exercise, bending over, or lifting heavy objects for two weeks to ensure the new delicate drainage channel remains stable.

  • Most patients experience a "stuffy nose" sensation rather than sharp pain, which is managed with prescribed nasal sprays and simple analgesics. While minor blood-stained spotting from the nose is normal for the first 24–48 hours, Dr Ladner’s precise surgical technique is designed to minimise the need for uncomfortable nasal packing.

  • While the blockage is bypassed immediately, your tearing may only fully resolve once the silicone stent is removed and post-surgical swelling subsides. Most patients notice a significant improvement in their comfort levels and a reduction in "sticky eye" infections within the first month.

  • A soft silicone stent is temporarily inserted to keep the new tear drainage channel open while the internal tissues heal. This "stent" is a thin, clear tube that is usually invisible to others and is easily removed by Dr Ladner during a quick follow-up visit in Durban.

  • Stent removal is a quick, painless procedure performed in Dr Ladner’s consulting rooms without the need for needles or anaesthesia. The silicone is simply snipped and slid out through the nose or eye in a matter of seconds, usually between 6 and 12 weeks post-op.

  • Most DCR procedures are performed under general anaesthesia to ensure patient comfort, though sedation with local anaesthesia is an option for some cases. You will typically spend a few hours in our day-clinic recovery area before being discharged home on the same day.

  • Most patients return to light work and normal activities within 7 to 10 days, though full internal healing takes several weeks. You should expect some mild bruising or "black eye" swelling around the nose and eyelid, which generally resolves within the first two weeks post-surgery.

  • DCR surgery has a very high success rate, typically between 85% and 95% for most patients. Success depends on the underlying cause of the blockage; Dr Ladner uses high-definition endoscopic imaging to ensure the new opening is positioned for optimal long-term drainage.

Dr Grant Ladner | Eye Surgeon