DCR complication

[MRC5]

.I had a DCR surgery three and a half months ago.  Healing was many ups and downs of watery eye and dry eye days, but eventually was perfect...no watery eye expect if I yawned or put in an artificial tear.  Now the stent has been removed.  I feel air flowing over my eye when I breathe, particually when I inhale.  If I hold my breath my eye feels perfect (well perfect for me-I have LASIK induced dry eye).  Previous to DCR, my surgeon did a canaliculotomy on both eyes to see if smart plugs were there and if that was causing my blockage.  They were not, but the punctum/canaliculus was snipped.  My surgeon had said they could close it back up, but it did not affect the fuction of the eye.  He was right as it was not a problem afterwards, but with the DCR stent in place and now removed the slit seems longer and more open.  I am wondering if having the canaliculus "sewn" back up will help with the feel of air on my eye.  With pretty severe dry eyes, I can't tolerate this.  I even feel it when I'm trying to sleep.  Ouch!!!  I don't want to go back to full closure with punctal plugs either.  The plugs (smart lower and herrick upper) migrating through the system are what caused the inflammation/common canalicular scarring/complete obstruction/watery eye.  With severe dry eye and the disruption of my fragile tear film from the watering, it was pretty painful for me.  I've read common canalicular obstructions are not as successful in DCR as when it's in the lower system, so I am grateful my surgeon was able to correct the problem and it is a "success".  What are your thoughts on closing up the canaliculus helping with the air flow?  What about then cauterizing one puctum if needed?  I will never use plugs again (maybe a dissovable) or have total blockage.  Thanks for your advice.
Maurie .

[Ray T Oyakawa, MD]

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[JodieJ]

The phenomenon that you are experiencing is called "air reflux."  There is a 2007 paper by British researchers ("Air Reflux after External Dacryocystorhinostomy"--try googling) which describes it.  The authors conclude:  "Air reflux is common after external dacryocystorhinostomy, is associated with symptomatic success, and generally persists but is rarely troublesome."  Your experience of air reflux seems to be more severe than is typical.

Your surgeon can advise you about what can be done.  Maybe trying a dissolving (temporary) plug in one punctum would help.  Based on the outcome, you could decide whether or not to cauterize the punctum.  If the punctum is closed, there would be no need to close the canaliculus.

There were some posts on this site by an Australian man who had similar problems following a DCR.  You can find them using the search feature.