Impaired tear drainage
Confirmed distal nasolacrimal duct obstruction with persistent epiphora.
About the service
Dacryocystorhinostomy creates a new drainage route from the lacrimal sac into the nose. It is considered for obstruction at the appropriate level after lacrimal assessment.
Who the service is for
Recurrent lacrimal-sac inflammation
Chronic or recurrent dacryocystitis after the acute inflammatory episode has been controlled.
Scarring
Secondary obstruction after trauma, nasal surgery or scarring.
Retreatment
Recurrence after previous lacrimal surgery when the mechanism of failure has been identified.
Age considerations
Selected complex pediatric cases after specialist assessment and failure or inapplicability of less invasive options.
Tearing and lacrimal drainage
Do not attempt to probe or 'clear' the duct yourself and do not use antibiotic or steroid eye drops without medical advice.
Assessment before choosing treatment
Indications are determined by an ophthalmic surgeon after anatomical assessment. This section is not intended for self-diagnosis.
Access to the treatment area
Elective DCR may need to be postponed during acute systemic infection, decompensated medical illness, uncorrectable coagulopathy or active nasal/sinus disease that affects the planned route. Medications that alter bleeding risk must be managed through a clinical plan, not stopped independently.
Recurrent lacrimal-sac inflammation
Acute dacryocystitis with painful lacrimal-sac swelling requires treatment of the acute infectious-inflammatory episode first. Definitive drainage reconstruction is planned after stabilization.
Optical correction
If the cause of epiphora has not been localized, DCR should not be selected prematurely. Functional tearing, punctal malposition, ectropion and ocular-surface disease may need a different or combined approach.
Results and documents
Bring prior ophthalmology notes, irrigation/probing results, imaging and records of previous lacrimal, nasal or sinus surgery.
Eye injury
Tell the clinician whether tearing is unilateral or bilateral, whether there is purulent discharge, pain or swelling at the medial canthus, and whether you have had midfacial trauma.
Report regular medicines
Report anticoagulants, antiplatelet medicines and all regular medications. Do not stop them without a clinician-led plan.
Anaesthesia
Before surgery, ask KazRIED for the exact preoperative tests, fasting instructions and whether an ENT assessment is required.
When urgent care is needed
Rapidly increasing painful swelling near the inner canthus, fever, reduced vision or spreading redness requires urgent medical assessment. Urgent medical assessment is needed for rapidly increasing painful medial canthal swelling, fever, spreading redness of the eyelids or face, reduced vision, impaired eye movements or significant bleeding.
Limitations and safety
Urgent medical assessment is needed for rapidly increasing painful medial canthal swelling, fever, spreading redness of the eyelids or face, reduced vision, impaired eye movements or significant bleeding.
Book a consultation
Stages
Stage 1
Consultation.
The surgeon reviews tearing, prior inflammation, previous procedures, trauma and nasal disease.
Stage 2
Examination.
Eyelids, puncta, ocular surface, lacrimal-sac region and discharge are assessed.
Stage 3
Localization.
Irrigation, probing, contrast imaging and nasal evaluation are used selectively to identify the level of obstruction.
Stage 4
Method selection
The surgeon decides whether DCR is indicated, which access is appropriate and whether temporary intubation is useful.
Stage 5
Preoperative preparation.
Tests, consultations and fasting instructions are based on the selected procedure and anesthesia protocol.
Stage 6
Anesthesia.
The anesthetic technique depends on access, complexity, age and medical status.
Stage 7
Surgery.
A new lacrimal sac-to-nose opening is created; a temporary silicone system may be placed when indicated.
Stage 8
Postoperative review
Healing, ostium patency and the nasal cavity are assessed, along with stent position if a stent has been placed.
Service benefits
Bypassing the blocked segment
Dacryocystorhinostomy creates a new drainage route that bypasses an obstruction in the nasolacrimal duct.
Reduced watering
Restoring drainage can reduce persistent tear overflow when impaired tear drainage is the cause.
A connection between the tear sac and nose
The new opening allows tears to pass from the lacrimal sac into the nasal cavity through a new route.
A solution based on anatomy
The correction method is selected after assessing tear pathways, eyelid position and, when necessary, the nasal cavity.
Methods comparison
Criterion
External DCR
Endoscopic endonasal DCR (not performed in Almaty)
DCR + silicone intubation
Probing or dilation / intubation without DCR
Method principle
Creating a new lacrimal sac-to-nose opening through an external approach.
Creating a new opening from the nasal cavity under endoscopic control.
DCR with temporary silicone support of the new pathway when indicated.
Working within existing lacrimal pathways without a new opening.
Skin incision
Yes, at the inner eye corner.
No skin incision.
Depends on the DCR approach.
Usually no
Work in the nasal cavity
There is a nasal opening-creation stage, but sac access is external.
The main surgical approach is through the nose.
Depends on the DCR approach and intubation technique.
Limited to the probe or stent route.
Typical level of the problem
Distal nasolacrimal obstruction with patent canaliculi.
Distal nasolacrimal obstruction with suitable nasal anatomy.
DCR where the surgeon considers temporary lumen support beneficial.
Selected stenoses or congenital/proximal disease where DCR is not first choice.
Direct visualisation of the lacrimal sac
The most direct access to the sac and wall.
The sac is opened from the nose under endoscopic control.
Depends on the approach.
Not the method's goal.
Nasal anatomy assessment
Important before surgery, particularly with nasal disease.
Critical for the route and approach.
Depends on the DCR approach.
May matter in distal stenosis.
Ability to obtain tissue for suspected sac disease
External access facilitates direct assessment and biopsy of suspicious tissue.
Tissue sampling is possible when indicated, but the technique depends on the endoscopic findings and the team’s experience.
Depends on the approach and clinical goal.
Usually does not address diagnosis of sac disease.
Silicone stent
May be used, but not required in all primary cases.
May be used selectively.
Temporary intubation is part of the selected plan.
Intubation itself leaves a temporary stent.
Scarring / reclosure
Possible, making technique and follow-up important.
Granulation, synechiae and restenosis may occur.
A stent may help in selected cases but does not eliminate recurrence.
May not resolve dense distal obstruction requiring DCR.
Postoperative discomfort
Swelling, soreness and skin-wound care may occur.
Nasal discomfort, crusting and bloody discharge may occur.
Stent care and position checks are added.
Usually less extensive, but sensations depend on the procedure.
Repeat surgery
Possible for restenosis or recurrence.
Possible for opening scarring or another cause of failure.
Retreatment depends on the recurrence cause.
Repeating minor procedures instead of DCR may be inappropriate for persistent distal obstruction.
Status at KazRIED
The surgeon determines the approach; tariff applicability is confirmed.
The surgeon determines the approach; tariff applicability is confirmed.
DCR plus silicone intubation is not confirmed by separate tariffs.
Probing or dilation and intubation are confirmed as separate tariffs.
Public KazRIED price
Cost determined after consultation
Cost determined after consultation
The approach is not separately priced; do not automatically equate it with code 162-П.
from 24 000 ₸
External DCR
Method principle
Skin incision
Work in the nasal cavity
Typical level of the problem
Direct visualisation of the lacrimal sac
Nasal anatomy assessment
Ability to obtain tissue for suspected sac disease
Silicone stent
Scarring / reclosure
Postoperative discomfort
Repeat surgery
Status at KazRIED
Public KazRIED price
Creating a new lacrimal sac-to-nose opening through an external approach.
Yes, at the inner eye corner.
There is a nasal opening-creation stage, but sac access is external.
Distal nasolacrimal obstruction with patent canaliculi.
The most direct access to the sac and wall.
Important before surgery, particularly with nasal disease.
External access facilitates direct assessment and biopsy of suspicious tissue.
May be used, but not required in all primary cases.
Possible, making technique and follow-up important.
Swelling, soreness and skin-wound care may occur.
Possible for restenosis or recurrence.
The surgeon determines the approach; tariff applicability is confirmed.
Cost determined after consultation
Creating a new opening from the nasal cavity under endoscopic control.
No skin incision.
The main surgical approach is through the nose.
Distal nasolacrimal obstruction with suitable nasal anatomy.
The sac is opened from the nose under endoscopic control.
Critical for the route and approach.
Tissue sampling is possible when indicated, but the technique depends on the endoscopic findings and the team’s experience.
May be used selectively.
Granulation, synechiae and restenosis may occur.
Nasal discomfort, crusting and bloody discharge may occur.
Possible for opening scarring or another cause of failure.
The surgeon determines the approach; tariff applicability is confirmed.
Cost determined after consultation
DCR with temporary silicone support of the new pathway when indicated.
Depends on the DCR approach.
Depends on the DCR approach and intubation technique.
DCR where the surgeon considers temporary lumen support beneficial.
Depends on the approach.
Depends on the DCR approach.
Depends on the approach and clinical goal.
Temporary intubation is part of the selected plan.
A stent may help in selected cases but does not eliminate recurrence.
Stent care and position checks are added.
Retreatment depends on the recurrence cause.
DCR plus silicone intubation is not confirmed by separate tariffs.
The approach is not separately priced; do not automatically equate it with code 162-П.
Working within existing lacrimal pathways without a new opening.
Usually no
Limited to the probe or stent route.
Selected stenoses or congenital/proximal disease where DCR is not first choice.
Not the method's goal.
May matter in distal stenosis.
Usually does not address diagnosis of sac disease.
Intubation itself leaves a temporary stent.
May not resolve dense distal obstruction requiring DCR.
Usually less extensive, but sensations depend on the procedure.
Repeating minor procedures instead of DCR may be inappropriate for persistent distal obstruction.
Probing or dilation and intubation are confirmed as separate tariffs.
from 24 000 ₸
Book an appointment
Book a KazRIED consultation with an ophthalmic surgeon experienced in lacrimal disease. The clinician will identify the cause and level of obstruction and explain whether DCR, intubation or another treatment is appropriate.
Procedure prices
Service name
Price
Dacryocystorhinostomy (per eye)
from 192 000 ₸
Nasolacrimal duct intubation (per eye)
from 72 000 ₸
Nasolacrimal duct probing/ Lacrimal duct dilation (per eye)
from 24 000 ₸
Lacrimal irrigation (per eye / both eyes)
from 3 900 ₸
Contrast radiography of the lacrimal drainage system (per eye)
from 11 500 ₸
Ophthalmologist consultation, adults / children (per consultation)
from 12 000 ₸
Anesthesiologist consultation (per consultation)
from 6 500 ₸
Pre- and postoperative ophthalmologist monitoring (per consultation)
from 32 500 ₸
Adult surgical bed-day (per bed-day)
from 19 500 ₸
Our doctors
A team of experienced doctors across specialties.
Experience: 18 years
Head
Sultankulova Banu Tastemirovna
Highest-category ophthalmologist
Experience: 8 years
Ophthalmologist
Zhumakhanova Symbat Qymbatqyzy
First-category ophthalmologist
Experience: 7 years
Ophthalmologist
Sukbay Akbota Darkhanovna
Second-category ophthalmologist
Experience: 10 years
Ophthalmologist
Abilova Gulstan Kunshygharqyzy
Experience: 5 years
Ophthalmologist
Salikhova Anel Batyrbekovna
Experience: 8 years
Ophthalmologist
Seksenov Murat Qambaruly
Dacryocystorhinostomy: indications, surgical approach, and treatment planning
Dacryocystorhinostomy (DCR) creates a new tear drainage route between the lacrimal sac and the nasal cavity. It is primarily considered for persistent distal lacrimal drainage obstruction.
Normally, tears pass through the puncta, canaliculi, and lacrimal sac, then through the nasolacrimal duct into the nose. Persistent distal obstruction causes tear stagnation and epiphora and may lead to recurrent inflammation of the lacrimal sac.
How does DCR differ from other procedures?
DCR creates a bypass rather than reopening the blocked nasolacrimal duct. It therefore addresses a different anatomical problem from irrigation, probing, dilation, or intubation alone.
It does not replace reconstruction of a damaged canaliculus or correct an everted punctum. A more proximal obstruction may require canalicular reconstruction or intubation, while selected patients with partial stenosis may benefit from less extensive procedures.
What must be established before surgery?
The clinician must confirm that symptoms arise from impaired tear drainage and identify the level of obstruction.
Tearing can occur with dry eye, eyelid or punctal malposition, and lacrimal pump weakness even when the drainage system is anatomically patent. DCR may not resolve the underlying symptom mechanism in these situations.
If irrigation is free, the ocular surface, eyelid position, and lacrimal pump function are assessed further.
How is the surgical approach selected?
DCR can be performed through an external or an endoscopic endonasal approach. Current comparative studies do not establish either as universally superior: both can achieve good results.
The choice depends on anatomy, obstruction level, nasal cavity condition, the need for direct access to the lacrimal sac, and the team’s experience.
When is a tailored approach needed?
- Chronic dacryocystitis with confirmed distal obstruction: DCR may be considered after acute inflammation has been controlled.
- Tearing recurs after DCR: the surgical opening, granulation tissue, scarring, stent position if present, and alternative causes of epiphora are assessed.
- Obstruction follows midfacial trauma or nasal surgery: joint assessment by an ophthalmic surgeon and an ENT specialist may be needed.
- Congenital obstruction persists in a child after previous procedures: the decision follows a separate pediatric pathway.
Which services are considered separately?
- Nasolacrimal duct probing and dilation: separate procedures that are not DCR.
- Contrast radiography of the lacrimal pathways: a diagnostic service used when indicated, rather than for every patient.
- Anesthesiology consultation: the need depends on the anesthesia selected and the protocol.
- An adult surgical inpatient day: a separate inpatient service that is not required for every patient after DCR.
How should patients traveling from another city prepare?
Before traveling, gather medical reports and test results and confirm the diagnostic stages, need for admission, and follow-up schedule with KazRIED.
Treatment planning begins with identifying the mechanism of tearing and the level of dysfunction. The approach, need for a stent, anesthesia, costs, and follow-up are discussed afterward.
Facts and offers
Kazakhstan’s first specialized ophthalmology institute, operating since 1933.
Modern diagnostics and surgery using world-class equipment.
Leading ophthalmologists in Kazakhstan, scientists and experienced surgeons.
More than 30,000 operations and around 270,000 consultations annually.
Kazakhstan’s first specialized ophthalmology institute, operating since 1933.
Modern diagnostics and surgery using world-class equipment.
Leading ophthalmologists in Kazakhstan, scientists and experienced surgeons.
More than 30,000 operations and around 270,000 consultations annually.
Kazakhstan’s first specialized ophthalmology institute, operating since 1933.
Modern diagnostics and surgery using world-class equipment.
Leading ophthalmologists in Kazakhstan, scientists and experienced surgeons.
More than 30,000 operations and around 270,000 consultations annually.
Related services
Frequently asked questions
What is dacryocystorhinostomy?
Dacryocystorhinostomy, or DCR, is surgery that creates a new tear-drainage pathway from the lacrimal sac directly into the nasal cavity, bypassing an obstructed nasolacrimal duct.
When may DCR be needed?
DCR may be considered for clinically significant persistent nasolacrimal duct obstruction, chronic or recurrent dacryocystitis and persistent tearing when impaired drainage has been confirmed as the cause.
Does every case of persistent tearing require DCR?
No. Tearing can also result from dry eye, ocular-surface inflammation, eyelid or punctal malposition, lacrimal pump dysfunction and other causes. The mechanism of epiphora should be identified first.
How is DCR different from lacrimal irrigation?
Irrigation is used primarily to assess anatomical patency of the drainage system. DCR is surgery that creates a new drainage pathway to bypass a persistent obstruction.
How is DCR different from probing?
Probing passes an instrument through the existing lacrimal pathway to assess or traverse an obstruction. DCR bypasses the obstructed segment by creating a new connection between the lacrimal sac and the nasal cavity.
How is DCR different from lacrimal intubation?
Intubation leaves a temporary silicone stent within the existing drainage pathway to maintain patency. DCR creates a new drainage pathway. Intubation may form part of DCR in selected cases, but the procedures are different.
What are the main types of DCR?
The two principal approaches are external DCR and endoscopic endonasal DCR. External surgery uses a small skin incision near the inner canthus, while endonasal DCR is performed through the nasal cavity.
Which is better, external or endonasal DCR?
Neither approach is universally best. Selection depends on anatomy, the cause and level of obstruction, nasal findings, previous surgery and surgical expertise. Both can provide good outcomes when appropriately selected and performed.
Will DCR leave a scar?
External DCR uses a skin incision and therefore produces a scar whose appearance changes with healing. Endonasal DCR does not require an external skin incision.
Is a silicone stent always used during DCR?
No. Stent use is individualized according to lacrimal anatomy, scarring, primary versus revision surgery, surgical technique and other factors. It is not mandatory in every DCR.