Tear duct surgery (DCR)

What is tear duct surgery (DCR)?

Tear duct surgery, known medically as dacryocystorhinostomy (DCR), treats a blocked tear duct. Tears normally drain from the eye through small channels into a tear sac and then down a duct into the nose. If the duct below the sac is blocked, tears overflow, the eye waters constantly, and the sac can become infected (a painful swelling called dacryocystitis).

A DCR makes a new opening between the tear sac and the inside of the nose, bypassing the blockage so tears can drain again. It can be done from the outside, through a small cut beside the nose (external DCR), or from inside the nose using a telescope, with no skin cut (endoscopic or endonasal DCR). A fine soft tube (stent) is often placed temporarily to keep the new channel open while it heals.

DCR is mainly an operation for a watery or infected eye caused by a blockage below the sac. It does not treat watering from other causes, such as dry eye, eyelid problems or blockage of the tiny channels in the eyelids, which need different treatment. For most suitable blockages it works well, but success is not guaranteed and the channel can occasionally close again.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

External vs endoscopic DCR

Both approaches work well. The best choice depends on the cause and site of the blockage, your nose, and your surgeon's experience.

Preparing for your surgery

• See the surgeon (usually an oculoplastic or ENT specialist), who will confirm the blockage with an examination and tests such as syringing the tear duct.
• Tell the team about all medicines, especially blood thinners such as warfarin, apixaban or clopidogrel, which often need pausing as this surgery can bleed.
• Mention nosebleeds, nasal problems or previous nose surgery, as these can affect the operation.
• Have a pre-operative assessment if a general anaesthetic is planned.
• Arrange a lift home and someone with you for the first day, especially after sedation or a general anaesthetic.
• Plan around a week or two off work, and have ice packs and any prescribed drops or sprays ready at home.

What happens

A DCR is usually a day-case operation, done either under a general anaesthetic or under local anaesthetic with sedation.

For an external DCR, the surgeon makes a small cut on the side of the nose, opens the tear sac and removes a little bone to create a new channel into the nose. For an endoscopic DCR, the same new channel is made from inside the nose using a telescope, with no skin cut. A fine soft tube (stent) is often passed through the tear channels and into the nose to hold the new opening open while it heals.

The operation usually takes around 45 to 90 minutes. Afterwards the nose may be packed or you may have some bleeding, and most people go home the same day with instructions on drops, sprays and avoiding nose-blowing.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

The main issues to discuss are the chance that watering does not fully resolve (especially if more than one cause is present) and the small chance the channel closes again and needs a revision. Because this surgery can bleed, tell your surgeon about any blood thinners and bleeding tendencies. If you have a current tear-sac infection, this is usually treated before planned surgery.

Published figures to discuss

Success and complication rates depend on the cause and site of the blockage, the surgical approach, the use of a stent and whether more than one cause of watering is present. Figures below are cautious and drawn from published series; they describe averages rather than your individual chance.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

Recovery from a DCR is usually straightforward, with most people back to normal activities within a week or two. There is often some nasal bleeding and congestion early on, and any tube is removed at a later visit.

• Some blood-tinged fluid from the nose and a blocked nose in the first days
• Bruising and swelling around the eye after external surgery
• Awareness of the tube if a stent is in place
• Gradual improvement in watering over the first weeks
• A pink scar beside the nose (external surgery) that fades over months

Aftercare

• Keep your head raised and use ice packs in the first days to reduce swelling and bruising.
• Avoid blowing your nose and straining for the time your surgeon advises, to protect the new channel.
• Use any prescribed eye drops, antibiotic ointment or nasal spray as directed.
• Do not rub the eye or pull at any tube, and avoid swimming until your surgeon says it is safe.
• Sneeze with your mouth open in the early days to avoid pressure in the nose.
• Attend the appointment to have any tube removed and your healing checked.
• Keep the wound clean and protect the scar from strong sun after external surgery.

• Prescribed drops, ointment or nasal spray collected
• Ice packs ready at home
• Time off work booked (about 1–2 weeks)
• Lift home and someone with you for the first day
• Tube-removal appointment understood
• Advice on avoiding nose-blowing noted
• Clinic's contact number saved for problems

Scars and how they heal

External DCR leaves a small scar on the side of the nose, near the inner corner of the eye. It is pink and slightly firm at first and usually fades over a few months to become discreet. Endoscopic DCR is done through the nose and leaves no external scar at all. Protecting a healing scar from strong sun helps it settle.

⚠ Get urgent help if…

• Heavy or persistent nosebleeding that does not settle with simple measures
• Increasing redness, swelling, heat or discharge around the wound or eye (possible infection)
• A fever or feeling generally unwell after surgery
• Severe or worsening eye pain, or any change in or loss of vision — seek help immediately
• Double vision or a problem moving the eye
• A tube that has come loose, is hanging out or is causing severe irritation

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result means the eye stops overflowing and any repeated tear-sac infections settle, because tears can now drain through the new channel into the nose. Success is commonly around 90% for blockages below the tear sac, and is broadly similar for external and endoscopic surgery in suitable patients.

It can take a few weeks for watering to improve fully, especially while a tube is in place. DCR does not treat watering from other causes, so if dry eye, eyelid laxity or blockage higher up in the eyelid channels is also present, some watering may remain and further treatment may be needed.

For most people a successful DCR gives lasting relief because the new drainage channel stays open. In a minority the channel narrows or closes again over time, the watering returns and a revision operation may be considered, sometimes using a stent or other measures to improve the chance of staying open. Blockages within the tiny eyelid channels (rather than below the sac) are harder to fix and have lower success.

Combining with other procedures

A DCR is sometimes combined with other tear-drainage or eyelid procedures if more than one problem is contributing to the watering — for example, eyelid tightening if the lid is lax, or opening of the tiny eyelid channels. Your surgeon will assess the whole tear-drainage pathway and explain what is planned.

Follow-up & long-term care

You will be seen to check healing, remove any skin stitches and later remove the tube (stent), usually a few weeks after surgery. Watering is reassessed once the channel has settled. Report heavy bleeding, infection signs, or any eye pain or vision change promptly.

• Attend the appointment to have any temporary tube removed at the planned time.
• Use prescribed drops or sprays for the full course to support healing.
• Avoid nose-blowing and heavy straining while the channel heals.
• Seek review if watering returns, in case the channel has narrowed.

Revision and secondary surgery reality

• If the new channel narrows or closes, watering returns and a revision DCR may be considered.
• Revision surgery may use a temporary tube (stent) and is more complex than the first operation.
• Blockages in the tiny eyelid channels are harder to treat and may need different procedures.
• Some people have more than one cause of watering, so a single operation may not fully cure it.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

• Clear written instructions on drops, sprays, avoiding nose-blowing and what to watch for.
• A planned appointment to remove the tube and check the channel.
• A named contact and a number to call for heavy bleeding, infection or eye symptoms.
• Reassessment of watering once healing has settled, with onward referral if another cause remains.
• Prompt review if watering returns, suggesting the channel may have narrowed.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• The surgeon's fee and the anaesthetist's fee (general anaesthetic or sedation)
• Theatre and day-case facility charges
• Whether the surgery is external or endoscopic, and any equipment used
• Any tube (stent) used and its later removal
• Tests beforehand to confirm and locate the blockage
• Follow-up appointments
• Cover for managing complications or a revision if needed

• The surgeon's fee and the anaesthetist's fee
• Theatre and day-case charges and any tube used
• The appointment to remove the tube and check healing
• Follow-up appointments and any tests
• What happens, and who pays, if watering persists or the channel closes
• The cancellation policy
• Whether a revision operation would be covered if the first one failed

On the NHS? Tear duct surgery is commonly funded by the NHS when a blocked tear duct causes a troublesome watery eye or repeated infections; private care is sometimes used for a shorter wait or choice of surgeon.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a surgeon safely

• Check your surgeon is on the GMC Specialist Register for this area.
• Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
• You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
• Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good surgeon will welcome every one of these.

• Where exactly is my blockage, and is a DCR the right operation for it?
• Would you recommend an external or endoscopic approach for me, and why?
• Will you use a tube, and when would it be removed?
• What is the chance the watering does not fully resolve, or comes back?
• Could anything else be contributing to my watery eye?
• What should I do if I get heavy nosebleeding or eye pain afterwards?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the surgeon who carries out my operation, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this operation not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified surgeon for tear duct surgery (dcr)

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: Hull University Teaching Hospitals NHS — DCR patient information Leeds Teaching Hospitals NHS — Dacryocystorhinostomy Moorfields Eye Hospital NHS — Patient information leaflet library Endoscopic DCR — techniques and outcomes review (PMC) Causes and management of failed endonasal DCR (PMC)

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.