Endonasal DCR (Scarless Tear-Duct Repair)

Functional oculoplastic surgery focuses on the eyelids, eye sockets and facial structures around the eye area. It’s a highly specialised surgical procedure combining ophthalmology and plastic surgery. The surgeries are also delicate and involve operating on incredibly fine structures.


Dr Nick Koutroumanos, a London-based oculoplastic surgeon specialising in watery eye conditions, offers exceptional care and expertise to patients seeking relief through Endonasal Dacryocystorhinostomy (DCR) surgery. Personalised consultations, comprehensive patient education, and meticulous guidance throughout the surgical journey ensure the highest standard of care for individuals seeking relief from watery eye conditions.

Endonasal DCR surgery is a minimally invasive technique meticulously designed to restore normal tear drainage in individuals suffering from watery eyes caused by nasolacrimal duct obstruction.

This surgical approach offers significant advantages over traditional external DCR with benefits such as a shorter recovery duration, enhanced cosmetic results, and reduced risk of complications.

Who is an ideal candidate for Endonasal DCR Surgery?

Accurate diagnosis of nasolacrimal system stenosis or obstruction is crucial as only a relatively small proportion of watery eyes is attributable to a blocked tear duct.

Dr Koutroumanos conducts a comprehensive evaluation of patients experiencing watery eyes due to nasolacrimal duct obstruction, examining medical history, conducting tests like lacrimal sac syringing, and employing imaging studies to confirm the diagnosis and assess eligibility for endonasal DCR surgery. This individualised assessment ensures that the treatment plan is tailored to the specific needs of each patient.

How should you prepare for Endonasal DCR Surgery?

To prepare for endonasal DCR surgery patients are advised to provide complete information regarding medications, allergies, and any relevant medical conditions.

Dr Koutroumanos will give you detailed pre-operative instructions, including fasting requirements and medication management guidelines. Specifically, blood-thinning medication will have to be paused.

What does Endonasal DCR Surgery involve?

  • Before Surgery: Patients are prepared for the procedure, and any necessary anaesthesia is administered. Dr Koutroumanos addresses concerns, ensuring patient comfort and well-being. Admission to a day surgery ward and a private room is facilitated, and the patient is prepared under the attentive care of nursing staff.
  • During Surgery: Employing minimally invasive techniques, DrvKoutroumanos accesses the blocked tear drainage pathway through the nasal cavity, utilising specialised instruments and endoscopic visualisation for precise manipulation. The surgery typically lasts between 45 to 90 minutes.
  • After Surgery: Patients are closely monitored in a recovery area until alert and stable. Temporary discomfort, swelling, or nasal congestion may occur but will diminish over time. Pain medication, nasal irrigation instructions, and comprehensive post-operative care guidelines are provided for a seamless recovery.

What are the risks and benefits of Endonasal DCR Surgery?

  • Benefits: Endonasal DCR surgery boasts a shorter recovery period, improved cosmetic outcomes (due to the absence of external incisions), and reduced complications, enhancing overall quality of life by addressing tear drainage obstruction effectively.
  • Risks: While generally safe and successful, endonasal DCR surgery carries potential risks such as bleeding, infection, scar tissue formation, nasal adhesions, persistent tearing, nasal crusting, nasal septum perforation (rare), and damage to surrounding structures (rare).

Dr Koutroumanos, a highly skilled oculoplastic surgeon in London specialising in endonasal DCR surgery, delivers exceptional care, expertise, and a commitment to excellent outcomes.

Oculoplastic surgeon London


Dr Nick Koutroumanos

Dr Nick Koutroumanos is a London-based Ophthalmic & Oculoplastic surgeon, with particular subspecialty expertise in ophthalmic plastic & reconstructive eyelid, orbital and lacrimal surgery.

His private practice, based at The Hospital of St John & St Elizabeth in St John’s Wood complements his work in charge of a large NHS oculoplastics practice at the Royal Free Hospital in Hampstead.

A qualified senior trainer and Royal College Examiner in ophthalmic plastic surgery, cataract surgery and general ophthalmology, he runs an Oculoplastics Fellowship training programme that is highly sought-after by both UK and international candidates.

Kind Words from Our Patients


A true perfectionist

Words are not enough to express my sincere gratitude for the care and dedication Dr Koutroumanos put into my journey. I felt safe and secure in his hands. This is someone who truly cares about outcome and ethics of practice. A true perfectionist. I would not hesitate to wholeheartedly recommend him.

100% worth it

I had surgery a few days ago with Dr Koutroumanos for congenital ptosis. It’s early days but I don’t think it’s too early to say the results will be life changing for me in terms of confidence levels. I struggled at school due to the condition and have learnt to live with it – that is until I saw the doctor who was reassuring from the start and has just done the best job. 100% worth it and amazing to know I was in such safe hands. I can’t thank him enough.

I’m really happy with my results

I’ve recently had a brow lift and blepharoplasty with Mr N Koutroumanos. The whole process from start to finish was handled professionally and each process was very informative. I’m still at the recovery stage, so far I’m really happy with my results. Highly recommend using Mr N Koutroumanos services.