Watery Eyes and Blocked Tear Ducts: DCR Surgery at Medicana Winchester
Persistent watery eyes can be frustrating, embarrassing and disruptive. Patients often describe tears running down the cheek, blurred vision from a constantly wet eye, repeated wiping, sticky discharge, soreness around the inner corner of the eye, or recurrent infections of the tear sac. The medical term for troublesome watering is epiphora.
One important cause of epiphora is a blocked tear drainage system. When tears cannot drain normally from the eye into the nose, they collect on the surface of the eye and overflow onto the face. For some patients this is intermittent; for others it becomes a constant daily problem.
At Hampshire ENT Clinics and Medicana Winchester, patients with watery eyes and blocked tear ducts can access a specialist lacrimal service combining ENT and ophthalmology expertise. The service is led by Mr Steve Hayes, Consultant ENT Surgeon and Rhinologist with specialist expertise in endoscopic nasal and lacrimal surgery, and Mr Simon Rogers, Consultant Ophthalmologist with specialist expertise in lacrimal and eyelid disease. Together, they provide joined-up assessment and treatment for epiphora, including dacryocystorhinostomy, commonly known as DCR surgery.
Quick answer: what is DCR surgery?
DCR stands for dacryocystorhinostomy. It is an operation to create a new drainage pathway between the tear sac and the inside of the nose, bypassing a blocked nasolacrimal duct. It is used to treat watery eyes caused by tear duct obstruction and may be performed using an external or endoscopic approach depending on the patient and anatomy.
How the tear drainage system works
Tears are produced by the lacrimal gland and spread across the eye with each blink. They usually drain through tiny openings in the eyelids called puncta. From there, tears pass through small channels called canaliculi into the lacrimal sac, then down the nasolacrimal duct into the nose.
This is why the nose can run when someone cries. The eye and nose are connected through the tear drainage system. If that pathway becomes narrowed or blocked, tears may overflow from the eye rather than draining normally.
What is epiphora?
Epiphora means excessive watering of the eye. It can happen because too many tears are produced, because the tear film is unstable, or because the tear drainage system is blocked.
Not all watery eyes are due to a blocked tear duct. Dry eye disease can paradoxically cause reflex watering. Eyelid malposition, blepharitis, allergy, conjunctivitis, corneal irritation and facial nerve problems can also cause watering. This is why specialist assessment matters. The correct treatment depends on the exact cause.
Symptoms of a blocked tear duct
A blocked tear duct may cause persistent watering from one eye, tears running down the cheek, blurred vision because of a watery tear film, sticky discharge, crusting of the eyelids, swelling near the inner corner of the eye, recurrent conjunctivitis-like symptoms or painful infection of the tear sac, known as dacryocystitis.
Some patients notice watering is worse outdoors, in wind, in cold weather or when reading. Others mainly notice discharge and stickiness. Symptoms can overlap with dry eye or eyelid disease, so a full ophthalmic and nasal assessment is often needed.
Why a joint ENT and ophthalmology approach is valuable
DCR surgery sits at the interface between the eye and the nose. The ophthalmologist assesses the eyelids, puncta, canaliculi, tear sac and ocular surface. The ENT rhinologist assesses the inside of the nose, nasal septum, turbinates, sinus anatomy and the nasal space where the new tear drainage opening will be created.
This combined approach is one of the strengths of the Medicana Winchester lacrimal service. Mr Simon Rogers brings ophthalmic lacrimal expertise, while Mr Steve Hayes brings advanced endoscopic nasal and rhinology expertise. For patients, this means the eye and nose aspects of epiphora can be considered together rather than in isolation.
What causes blocked tear ducts in adults?
In adults, nasolacrimal duct obstruction may occur without a clear cause. It can also be associated with inflammation, previous infection, trauma, previous nasal or sinus surgery, sinus disease, nasal polyps, facial fractures, tumours, scarring or age-related narrowing.
Some patients have obstruction at the level of the punctum or canaliculi rather than the nasolacrimal duct. This distinction is important because the operation needed may be different.
How is a watery eye assessed?
Assessment usually begins with a careful history. The consultant will ask whether watering is one-sided or both-sided, whether there is discharge, whether infections have occurred, whether symptoms are worse outdoors, and whether there are dry eye, allergy or eyelid symptoms.
Eye assessment may include examination of the eyelids, puncta and ocular surface, and tests of tear drainage. Nasal assessment may include endoscopic examination of the nose to check septal deviation, inflammation, polyps, scarring or other anatomical factors that could affect surgery. Imaging may be recommended in selected cases, particularly if symptoms are unusual, complex or associated with sinus or nasal disease.
What is endoscopic DCR?
Endoscopic DCR is performed through the nose using a small camera and fine instruments. The surgeon creates a new opening between the lacrimal sac and the nasal cavity, bypassing the blocked duct. Silicone tubes or stents may be placed temporarily to support healing, depending on the case.
The endoscopic approach avoids a skin incision on the side of the nose and allows the ENT surgeon to address relevant intranasal anatomy at the same time. It is particularly valuable when nasal factors, sinus disease or previous surgery may affect access.
What is external DCR?
External DCR is performed through a small incision on the side of the nose near the inner corner of the eye. It gives direct access to the lacrimal sac and remains an important operation in selected patients. For some tear duct problems, an external approach may be recommended by the ophthalmologist.
The best approach depends on the site of blockage, previous surgery, anatomy, patient factors and surgeon expertise. A specialist lacrimal consultation helps determine whether endoscopic DCR, external DCR, revision surgery or another procedure is most appropriate.
Why Medicana Winchester is well placed for epiphora care
Medicana Winchester provides modern private hospital facilities with access to ENT, ophthalmology, endoscopy, theatre care and specialist equipment. For patients with watery eyes, this allows a streamlined pathway from diagnosis to treatment.
The centre is particularly well suited to epiphora and DCR care because the service brings together two complementary specialists: Mr Steve Hayes, a leading UK rhinologist and ENT surgeon with specialist lacrimal expertise, and Mr Simon Rogers, a leading UK ophthalmologist with expertise in lacrimal disease. This multidisciplinary model is especially helpful for patients with complex watering, previous failed surgery, nasal disease, sinus problems or uncertainty about whether the cause is ocular or nasal.
What happens after DCR surgery?
After DCR surgery, patients may have mild nasal bleeding, crusting, nasal congestion, bruising or discomfort. Eye drops, nasal sprays, saline rinses or antibiotics may be prescribed depending on the operation and surgeon preference. If silicone tubes are inserted, they are usually removed at a follow-up appointment.
Follow-up is important because the new opening needs to heal properly. Nasal endoscopy may be used to check the surgical opening, remove crusting and ensure the pathway remains patent. Patients should receive clear advice about nose blowing, activity, medication and what to do if bleeding or infection occurs.
Can DCR fail?
DCR is a well-established operation, but no procedure is guaranteed. Failure can occur if the new opening scars over, if the blockage is higher in the tear drainage system, if canalicular disease is present, if inflammation is significant, or if there are complex anatomical factors.
Revision DCR may be possible in selected cases, but it requires careful reassessment. A combined ENT and ophthalmology review is particularly useful for patients who have already had tear duct surgery elsewhere and remain symptomatic.
When should you seek specialist advice?
You should consider specialist assessment if you have persistent watery eyes, one-sided watering, recurrent sticky discharge, swelling near the inner corner of the eye, recurrent tear duct infections, previous failed tear duct surgery, or watery eyes associated with nasal blockage or sinus symptoms.
Hampshire ENT Clinics and Medicana Winchester offer specialist private assessment for epiphora and blocked tear ducts, with care led by Mr Steve Hayes and Mr Simon Rogers. The aim is to identify the true cause of watering and provide a clear, practical treatment plan.
Frequently asked questions
What does epiphora mean?
Epiphora means excessive watering of the eye. It may be due to blocked tear drainage, dry eye, eyelid problems, allergy, inflammation or other eye surface conditions.
What is DCR surgery?
DCR stands for dacryocystorhinostomy. It is an operation that creates a new drainage pathway from the tear sac into the nose to bypass a blocked tear duct.
Who needs DCR surgery?
DCR may be recommended for patients with persistent watering caused by nasolacrimal duct obstruction, especially when symptoms affect daily life or cause recurrent infections.
Is watery eye always caused by a blocked tear duct?
No. Dry eye, blepharitis, eyelid malposition, allergy and ocular surface irritation can all cause watering. Assessment is needed to confirm the cause.
What is the difference between endoscopic and external DCR?
Endoscopic DCR is performed through the nose without a skin incision. External DCR is performed through a small incision near the inner corner of the eye. Both can be effective in selected patients.
Will DCR leave a scar?
Endoscopic DCR avoids an external skin incision. External DCR uses a small skin incision that usually heals well, but the most suitable approach depends on the individual case.
Why does an ENT surgeon perform tear duct surgery?
The tear duct drains into the nose. ENT rhinologists have specialist expertise in nasal endoscopy, nasal anatomy and the intranasal part of DCR surgery.
Why is an ophthalmologist involved?
The ophthalmologist assesses the eye surface, eyelids, puncta, canaliculi and lacrimal sac. This helps confirm whether the watering is due to tear duct obstruction or another eye-related cause.
Can DCR help recurrent tear duct infections?
Yes. If infections are caused by poor tear drainage and blockage of the nasolacrimal duct, DCR may reduce the risk of recurrent dacryocystitis.
Are silicone tubes always needed?
Not always. Some surgeons use silicone tubes or stents in selected cases to support healing. The decision depends on the anatomy and type of blockage.
How long is recovery after DCR?
Recovery varies, but many patients return to light activities within days. Nasal crusting, mild bleeding or bruising can occur. Your consultant will give specific aftercare advice.
Can DCR be repeated if it has failed before?
Revision DCR may be possible, but it requires careful reassessment of the eye and nose to understand why the previous operation failed.
Where is DCR surgery performed privately in Hampshire?
Hampshire ENT Clinics offers specialist lacrimal assessment through Medicana Winchester, with a joint ENT and ophthalmology approach led by Mr Steve Hayes and Mr Simon Rogers.
Who are the DCR specialists at Medicana Winchester?
The service is led by Mr Steve Hayes, Consultant ENT Surgeon and Rhinologist, and Mr Simon Rogers, Consultant Ophthalmologist. Their combined expertise supports assessment and treatment of epiphora, blocked tear ducts and complex lacrimal problems.
How do I book an appointment?
Patients can contact Hampshire ENT Clinics or Medicana Winchester to arrange specialist assessment for watery eyes, blocked tear ducts, epiphora and DCR surgery.