[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Ophthalmology](https://durgical.com/en/ophthalmology/) › [Eye surgery and procedures](https://durgical.com/en/ophthalmology/areas/surgery/) › Lacrimal surgery: probing and dacryocystorhinostomy # Lacrimal surgery: probing and dacryocystorhinostomy - Topic A blocked tear duct causes watering and infection. Babies usually improve alone or with probing; adults often need a new passage into the nose (DCR). Updated Nov 13, 2026 **See it in 3D:** [Tear drainage](https://durgical.com/en/anatomy/lacrimal-canaliculus/) · [Lacrimal bones](https://durgical.com/en/anatomy/lacrimal-bone/) ## Key points - Congenital: valve of Hasner, usually clears in the first year. - Persistent congenital block: probing. - Adult block: dacryocystorhinostomy. - Acute dacryocystitis: antibiotics first, surgery later. - Bloody tears: think of a tumour. ## What it is Tears drain through the puncta and canaliculi into the lacrimal sac and down the nasolacrimal duct into the nose. In babies the block is usually a membrane at the lower end of the duct (valve of Hasner) that often opens by itself in the first year; persistent cases are treated by probing, with silicone tubes or balloon dilation if probing fails. In adults, acquired duct obstruction causes watering and dacryocystitis and is treated by dacryocystorhinostomy (DCR), which joins the sac to the nose through the skin or endoscopically. ## Key facts - Congenital obstruction: most cases clear by the first birthday with lid hygiene and sac massage; probing is offered if it persists. - Irrigation of the drainage system and the dye disappearance test show whether the passage is open and roughly where it is blocked. - DCR succeeds in most adults (around nine in ten); an endoscopic approach avoids a skin scar. - Acute dacryocystitis: treat the infection with systemic antibiotics first; DCR is done once it has settled. - Adult obstruction is mostly idiopathic in older women, but think of sinus surgery, facial fractures, sarcoidosis, granulomatosis with polyangiitis and tumours. - Congenital dacryocele: a bluish swelling at the inner corner at birth; it can become infected or block the nose in a newborn. ## In clinical practice - Before blaming the duct in an adult with watery eyes, look for lid malposition, lash problems and dry eye causing reflex tearing. - Bloody tears or a firm mass above the medial canthal tendon suggest a tumour of the lacrimal sac. - After DCR, minor nosebleeds are common; patients avoid blowing the nose hard for some days. ## Next step / Initial management - Baby with a watery, sticky eye: teach lid cleaning and sac massage; refer for probing if still present near the first birthday, or earlier with repeated infections. - Newborn with a blue swelling at the inner corner (dacryocele): prompt ophthalmology, urgent if it is infected or the baby has trouble breathing. - Painful red swelling at the inner corner (acute dacryocystitis): systemic antibiotics and urgent ophthalmology; DCR once settled. - Adult with persistent watering: refer for lacrimal irrigation and assessment for DCR. - Bloody tears or a hard mass over the sac: urgent referral to exclude a tumour. ## Test yourself Think of the answer, then tap the question to see it. ## Where is the usual block in congenital nasolacrimal duct obstruction? At the lower end of the duct, the valve of Hasner. ## What does a dacryocystorhinostomy create? A new passage between the lacrimal sac and the nasal cavity. ## Why is the lacrimal system not probed during acute dacryocystitis? It can spread the infection; systemic antibiotics come first and surgery once it has settled. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/ophthalmology/lacrimal-surgery-probing-and-dacryocystorhinostomy/) ## Connections ## See it in 3D 2 The structures of Durgical's 3D anatomy where it is found. - [Tear drainage](https://durgical.com/en/anatomy/lacrimal-canaliculus/) - [Lacrimal bones](https://durgical.com/en/anatomy/lacrimal-bone/) ## Related 3 - [Tear production and drainage](https://durgical.com/en/ophthalmology/tear-production-and-drainage/) - [The watering eye (epiphora)](https://durgical.com/en/ophthalmology/the-watering-eye/) - [The tearing or red-eyed infant](https://durgical.com/en/ophthalmology/the-tearing-or-red-eyed-infant/) ## Related conditions 3 - [Congenital nasolacrimal duct obstruction](https://durgical.com/en/conditions/congenital-nasolacrimal-duct-obstruction/) - [Dacryocystitis and nasolacrimal duct obstruction](https://durgical.com/en/conditions/dacryocystitis-and-nasolacrimal-duct-obstruction/) - [Ectropion and entropion](https://durgical.com/en/conditions/ectropion-and-entropion/) [← All of ophthalmology](https://durgical.com/en/ophthalmology/) Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once. Sources: [Dacryocystorhinostomy](https://www.ncbi.nlm.nih.gov/books/NBK557851/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Nasolacrimal Duct Obstruction](https://www.ncbi.nlm.nih.gov/books/NBK532873/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Congenital Nasolacrimal Duct Obstruction](https://www.ncbi.nlm.nih.gov/books/NBK559267/) (StatPearls Publishing (NCBI Bookshelf), 2026); [Dacryocystitis](https://www.ncbi.nlm.nih.gov/books/NBK470565/) (StatPearls Publishing (NCBI Bookshelf), 2025). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/ophthalmology/lacrimal-surgery-probing-and-dacryocystorhinostomy/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ophthalmology/lacrimal-surgery-probing-and-dacryocystorhinostomy/