A blockage can occur at any point in the tear drainage system, or a nasolacrimal duct obstruction, from the puncta to your nose. When that happens, your tears don’t drain properly, giving you watery eyes and increasing your risk of eye infections and inflammation.

Depending on the severity of your blockage, surgical treatment may be recommended. For a full blockage of your tear drainage system, a balloon catheter dilation is recommended.

David Silbert, MD, FAAP conducts this procedure endoscopically and it is often referred to a DCR procedure.


Before an endoscopic DCR, patients will first have a probe and irrigation (see probe and irrigation handout) either in the office for adults or at the outpatient surgery center for young children.


An Endoscopic Dacryocystorhinostomy (DAK-ree-oh-sis-toe-rye-nohs-tuh-me) or DCR, is a procedure conducted when you have full obstruction of the tear duct. This procedure opens the passageway for tears to drain out your nose again. Dr. Silbert will use a microscopic camera and other tiny instruments inserted through the nasal opening to your duct system.

The procedure consists of entering the duct anatomy through the nose and inserting the balloon. One the balloon is inserted, Dr. Silbert will inflate the balloon for one minute, deflate, and then reposition the balloon higher and reinflate once or twice. The balloon is removed at the end of this procedure. There is no implant.

This procedure can be performed on children and adults in an outpatient surgical facility under general anesthesia.

Post-Surgical Follow Up

Postoperative care frequently includes the use of a topical antibiotic and corticosteroid eyedrops, as well as oral antibiotics and/or corticosteroids

Why Dr. Silbert

Dr. Silbert is one of only and handful of surgeons in the country who perform this procedure endoscopically. This means, there is on incision on the outside of the face and there is no scarring. Performing the procedure endoscopically also means the surgery is less invasive and safer for the patient.