Is there surgery for a blocked tear duct in Malaysia? DCR, who does it and when

Yes. The operation is called dacryocystorhinostomy, or DCR, and in Malaysia it is performed by oculoplastic and lacrimal eye surgeons, sometimes with an ENT surgeon for the nasal route. Dr Catherine Chow, oculoplastic surgeon, explains here when surgery is considered, the two routes in and what to ask.

My eye keeps watering and the tear duct feels blocked. Is there surgery for this in Malaysia?

Yes, the surgery is DCR, and it is a recognised operation that is done in Malaysian hospitals. DCR makes a new drainage channel from the tear sac, the small pouch beside the nose, directly into the nose, so tears bypass a blocked tear duct (the nasolacrimal duct). Cambridge University Hospitals describes it as removing a piece of bone from the side wall of the nose and connecting the sac to the nasal cavity.

It is done by oculoplastic surgeons, who are ophthalmologists with extra training in eyelids and tear drainage, and by ENT surgeons who work through the nose. A Malaysian report from an ENT department in Temerloh, Pahang, reviewed 45 patients who had endoscopic DCR between 1998 and 2005 and concluded it was an efficient treatment with minimal complications. That is a small, older, single-centre review, and it shows only that the operation has long been done here.

Surgery is not the first step for every watering eye. NHS guidance lists blocked tear ducts among several causes of watering, alongside allergy, infection, dry eyes and an eyelid that droops away from the eye. My article on watery eyes and DCR sets out the whole picture, and the rest of this page answers the narrower question of who does the operation and when it is the right one. The other drainage problems sit together under watery eyes and blocked tear ducts. Dr Catherine Chow begins consulting at Eagle Eye Centre Malaysia, Petaling Jaya, from early 2027.

How does a doctor decide that the tear duct is really blocked?

By looking at the eyelids and the tear drainage openings, then testing whether fluid can pass through. The first look checks the lid position, the tiny drainage openings (the puncta) on the inner edge of each lid, the surface of the eye and the inner corner for swelling or discharge.

The commonest test is irrigation, also called syringing: salt water is gently flushed through the drainage system to see whether it reaches the nose and throat. Probing passes a fine instrument along the same route to find where it stops. Where the system is open but the eye still waters, imaging can be added. A 2025 systematic review from Universiti Sains Malaysia and Leeds proposes contrast imaging (dacryocystography) for everyone with functional epiphora, which is watering with an open system, and a nuclear tear-flow scan (dacryoscintigraphy) if that is normal. That is one group's proposed pathway, not a rule every unit follows.

The point of the work-up is to find where the problem is. A blockage in the punctum, the canaliculus (the thin channel in the lid), the sac or the duct each need a different answer, and DCR treats only the last two.

What is the difference between external and endoscopic DCR?

The difference is the route to the tear sac. External DCR goes through a small cut in the skin beside the nose, and endoscopic (endonasal) DCR goes through the nose with a small telescope, so there is no skin cut. In both, bone is removed, an opening is made between sac and nose, and a thin silicone tube is usually left in place for about six weeks, according to Cambridge University Hospitals.

The published comparisons are careful and cautious, and it is worth reading what they actually say.

• A 2014 meta-analysis in Orbit pooled 19 studies (4 randomised trials and 15 cohorts). Overall, external DCR had slightly better success than endoscopic (risk ratio 0.96, confidence interval 0.93 to 1.00). Endoscopic DCR done with a mechanical drill was comparable to external (1.02), while laser-assisted endoscopic DCR did worse (0.85). Scarring was far less with the endoscopic route (risk ratio 0.07) and infection was lower (0.24), and the rate of revision surgery was similar.
• A 2017 Cochrane review found only two small trials, 104 people in all, of poor reporting quality. Mechanical endonasal and external DCR both had a success of 90% in one trial of 40 participants, while laser-assisted endonasal DCR had 63% against 91% for external in the other. The authors rated the evidence very low in certainty and concluded that the relative effects remain uncertain.
• Cambridge University Hospitals tells patients that around 90% have a successful outcome with external DCR and about 85 to 90% with endoscopic DCR, and that the two are similar.

These figures describe groups of patients in particular studies, with different definitions of success, and cannot predict one person's result. What the pooled evidence does show is that the way the endoscopic operation is done matters: done with mechanical instruments, it was comparable to external DCR, while laser-assisted endoscopic methods did less well. The endoscopic route also avoids a skin scar.

When is surgery not the answer for a watering eye?

When the blockage is not in the sac or duct, or when the drainage system is open and something else is making the eye water. A good assessment looks for these first, because an operation on the wrong part of the system would not help.

• Narrowed drainage openings. A tight punctum is treated at the lid, as described in punctal stenosis, the small opening that makes an eye water. Blockage of the thin channel is a separate problem, covered in canalicular blockage and silicone tubes.
• Dry eye. NHS guidance notes that dry eyes can make the eye produce too many tears. Treating the surface, not the duct, is the answer; watery eyes in adults: too many tears or poor drainage explains how the two are told apart.
• Eyelid position. A lower lid that turns out, as in ectropion, or in, as in entropion, stops tears reaching the drain or irritates the eye. Fixing the lid is a different operation.
• Loose conjunctiva. Redundant folds on the white of the eye can block tear flow, which is the subject of conjunctivochalasis.

For a duct that is blocked in an adult, simple measures do not open a scarred channel. My article on massage and warm compresses for adults explains what they can and cannot do.

What are the risks of DCR and what does recovery involve?

The main risks are bleeding, infection, scarring and failure of the new channel to stay open. Cambridge University Hospitals lists slight bruising and swelling that usually settles in about a fortnight, nasal bleeding that is common in the first days, a rare severe nosebleed up to ten days later, a small risk of infection, and a very rare leak of the fluid around the brain. It adds that the surgery can fail in a minority of people, usually because scar tissue forms inside the nose and blocks the new channel.

The same leaflet says that about 3% of people notice the skin scar after three months with the external route. Blood-thinning medicines raise the nosebleed risk, so a surgeon asks about them in advance, and nobody should stop such a medicine without advice from the doctor who prescribed it.

Day-by-day recovery is set out in DCR surgery: what happens and recovery. If the channel closes again, DCR surgery when it fails and what a repeat involves covers the options.

Who should I see, and how do I check they are registered?

Start with an ophthalmologist, ideally one with oculoplastic or lacrimal training, who can tell which part of the system is blocked. An ENT surgeon is also part of the picture where the nasal route is used. What an oculoplastic surgeon is and when to see one explains the training.

Before any operation, check that the surgeon is on the Malaysian Medical Council register and the National Specialist Register. The steps are in how to check an eye surgeon is registered in Malaysia. Questions worth asking are which route is planned and why, who does the operation, how many weeks the tube stays in, and what the plan is if the channel closes.

When should I go urgently?

Go the same day if there is a red, swollen, painful lump at the inner corner of the eye, especially with fever or swelling that spreads to the eyelids or cheek. This can be an infected tear sac, called dacryocystitis, and it needs treatment promptly. Dacryocystitis, the infection of a blocked tear duct sets out the signs.

NHS guidance also lists vision changes and severe eye pain as reasons to seek urgent help with any eye problem. A watering eye that is merely a nuisance can be assessed in the usual way, and the wider context is in why eyes look tired.