Check with your GP whether it is safe to stop medications and common supplements that may increase bleeding and/or prevent clotting. You may need to stop several weeks before your surgery.
Your doctor is likely to recommend:
Tell your doctor about all the medicines and supplements you take. If your doctor advises not to stop taking a medicine or supplement, tell Mr Malhotra.
It is advisable to stop smoking at least three weeks before surgery and not to smoke until at least two weeks after wounds are fully healed. Nicotine closes the blood vessels responsible for bringing oxygenated blood – vital for healing – to the tissues. Oxygen also fights infection and helps to keep tissue alive, as well as being instrumental in delivering important medications like antibiotics. Smoking clogs the lungs and therefore increases risk of pulmonary infections, such as pneumonia.
If you are having a local anaesthetic:
Whether you are having a local or general anaesthetic:
If your operation is scheduled for the morning:
If your operation is scheduled for the afternoon:
Bruising is almost universal with the external DCR and uncommon with the endoscopic approach. It should clear in one to two weeks. Swelling and bruising may seem to be worse the day after surgery and the discolouration may run down your face from your cheeks to your chin. Both are normal and will soon fade.
You may bleed from the nose in the days following surgery. Usually this is minimal and takes place in the first 24 hours. Rarely, it may be severe, take place any time in the first post-operative week and need further treatment. If nose bleeding occurs after surgery, stay calm, sit down and apply gentle pressure to the nose with a tissue or flannel. The bleeding will normally stop after a few minutes. If it persists and is severe, go to a hospital emergency department where it can be assessed and treated.
There is a visible scar on the skin with an external DCR. This fades with time and is usually virtually invisible after a few months. Rarely, a prominent scar forms that might require revision surgery to make it less visible. There is no visible scar after endoscopic surgery.
Infection is rare after DCR surgery. Antibiotics are usually given during the surgery and may be prescribed post-operatively. If infection develops, there is pain, redness and swelling in the operated area and there may be a discharge of pus. You should contact Mr Malhotra if you are concerned.
Fine silicone tubes are usually placed in the tear ducts at surgery and secured in the nose. If the tube loosens, it may form a prominent loop on the surface of your eye. If this happens, do not worry – it is not a serious problem. Tape the tube to your cheek or nose, away from your eye, and see your doctor so that the tube can be repositioned or removed.
This can happen very occasionally after successful surgery. You may need to use artificial tears, or even a plug in the tear duct – a punctal plug.
DCR surgery can fail when an obstruction to the free drainage of tears recurs. Most commonly, this is caused by scarring along the new passage. On average, this happens to one out of 20 patients with nasolacrimal duct obstruction. The rate of failure is roughly equal for the external and endonasal techniques. A revision operation may be performed to try to overcome any recurrent obstruction and watering after a failed DCR. Occasionally, there may be another cause for the watering that requires a different form of treatment.