How DCR Surgery Creates a New Tear Drainage Path: Endoscopic and External Approaches

She has started carrying two tissues in every coat pocket. One for the eye, one for the camera lens that keeps fogging when she wipes her cheek. In supermarkets people ask if she is all right. On the school run a child offers a hug. The tear duct on her left side has simply stopped draining, and the overflow has become a small daily negotiation with the world.

When her ophthalmologist mentions a dacryocystorhinostomy, the word alone feels like a hurdle. What she actually wants to know is simpler: dcr surgery, how it works, where the new drain goes, whether it involves the nose, and why anyone would choose a cut on the face over a camera through the nostril.

Those are fair questions, and the answers are more mechanical than mysterious. A DCR is, at heart, plumbing. The surgeon does not unblock the old pipe. The surgeon builds a short new one.

DCR surgery: how it works, step by step

Dacryocystorhinostomy is a long name for a short idea. Dacryo means tear, cyst means sac, rhino means nose, and stomy means making an opening. Put together, the word describes exactly what the surgeon does: an opening is made from the tear sac directly into the nose.

To see why that helps, picture the normal route. Tears wash across the eye and drain through two tiny holes on the inner edge of each eyelid, called puncta. From there they travel along small channels into the lacrimal sac, a pouch tucked against the bone beside the nose, then down a narrow bony tube, the nasolacrimal duct, which empties inside the nose. In most adults who need a DCR, the blockage sits in that lower tube, often with no clear cause (Mayo Clinic).

The surgeon cannot easily reopen a scarred bony tube, so the operation leapfrogs it. Working either through a small skin incision or through the nostril, the surgeon exposes the thin bone separating the lacrimal sac from the nasal cavity, removes a window of that bone, and opens the sac wall. The sac lining and the nasal lining are then brought together, sometimes with stitches, so they heal as a single continuous tunnel. Tears can now flow from the sac straight into the nose, several centimeters upstream of the old blockage.

Many surgeons thread a soft silicone loop through the new passage and out through the puncta. This stent is a placeholder, not a permanent part, and it is usually removed in clinic once healing has settled (Mayo Clinic). That is the whole operation. Everything else, from the choice of approach to the recovery timeline, is a variation on this one theme.

Why does a blocked tear duct cause watering, and sometimes infection?

A tear duct that no longer drains behaves like a sink with a clogged outlet. The tap keeps running, because the lacrimal gland above the eye produces tears all day, but the water has nowhere to go except over the rim. That is why the main symptom of a nasolacrimal duct obstruction is a constantly watery eye, often worse in wind or cold, when tear production rises (NHS).

Standing water invites trouble. Tears pooling in the lacrimal sac can become a warm, protein-rich reservoir for bacteria, and the sac can become infected and inflamed, a condition called dacryocystitis. People describe a tender, red swelling between the inner corner of the eye and the bridge of the nose, sometimes with sticky discharge or pus that can be expressed by pressing on the sac (MedlinePlus). Repeated infections are one of the strongest reasons surgeons move from watchful waiting to a DCR, because each episode leaves more scar tissue and makes the blockage more complete.

The causes in adults are varied and often unexplained. Age-related narrowing of the duct, previous nasal or sinus surgery, facial injury, chronic sinus inflammation, certain eye drops used long term, and, rarely, tumors in the drainage pathway can all contribute (Mayo Clinic). Women are affected more often than men, which is thought to relate to a naturally narrower bony canal.

Before any operation, the clinician will confirm where the blockage sits. A common clinic test involves flushing sterile saline through the puncta with a fine blunt cannula; if the fluid reaches the throat, the system is open, and if it refluxes back out through the other punctum, the lower duct is blocked. Imaging is reserved for unusual cases. Knowing the level of the blockage matters, because a DCR only helps when the problem lies at or below the sac.

Who is DCR surgery usually for, and who is usually asked to wait?

The typical candidate is an adult whose nasolacrimal duct has been shown to be blocked, whose watering is intrusive enough to affect daily life, or who has had one or more bouts of dacryocystitis. Constant overflow can blur vision, chap the skin of the lower lid, and make reading, driving, and screen work genuinely harder. When symptoms reach that level and the blockage is confirmed to be low in the system, surgery becomes a reasonable conversation rather than a last resort (Mayo Clinic).

Several groups are usually asked to wait, or are steered elsewhere first. Infants are the clearest example. A blocked tear duct in a newborn is common, and the thin membrane at the bottom of the duct usually opens on its own during the first year of life, so babies are managed with gentle massage of the sac and observation rather than surgery; if it persists, a much simpler probing procedure comes before any thought of a DCR (Mayo Clinic).

Adults with an active, acute sac infection are generally treated with antibiotics prescribed by their clinician first, because operating on inflamed, swollen tissue raises bleeding risk and makes the anatomy harder to read. Once the infection has settled, the operation can be planned in calmer conditions.

People whose watering comes from something other than a true blockage also need a different plan. Loose or turned-out lower eyelids, blocked puncta, dry eye that triggers reflex tearing, and allergies can all mimic a drainage problem. A DCR would not help any of them. Finally, patients taking blood thinners, those with significant nasal disease such as large polyps or a severely deviated septum, and anyone with uncontrolled medical conditions will usually have those issues addressed or coordinated with the relevant specialist before a date is set. The treating team weighs all of this; no single factor decides it.

Endoscopic DCR vs external DCR: how the two approaches differ

Both approaches arrive at the same destination, a bony window between the sac and the nose. They differ in the road taken. External DCR begins with a short incision on the side of the nose, roughly between the inner corner of the eye and the bridge. The surgeon lifts the skin and soft tissue aside, exposes the sac and bone under direct vision, removes the bone, and sutures the sac lining to the nasal lining before closing the skin. It is the older of the two techniques and remains widely practiced.

Endoscopic DCR works from the inside. A slim rigid telescope with a camera, an endoscope, is passed up the nostril, and the surgeon watches a screen while removing nasal lining and bone from the inner side to reach the sac. There is no skin cut. Because the surgeon is looking at the nasal side of the anatomy, this approach also allows any nasal problem that might obstruct the new opening, such as a deviated septum, to be dealt with in the same session (Mayo Clinic).

Feature	External DCR	Endoscopic DCR
Route to the bone	Small skin incision beside the nose	Through the nostril with a camera
Visible scar	Yes, usually fine and fading	None on the skin
Suturing of sac to nasal lining	Commonly done	Usually not possible; linings are laid together
Nasal issues addressed at same time	Not directly	Often possible
Typical anesthesia	General or local with sedation	General or local with sedation
Silicone stent	Frequently placed	Frequently placed

Neither route is universally better. Surgeons choose based on training, the patient’s anatomy, previous nasal surgery, scar concerns, and whether a tumor needs to be ruled out, since the external route allows direct inspection of the sac. The honest answer to “which is best” is “the one your surgeon does well and that suits your anatomy.”

Does external DCR leave a scar on the face?

Yes, an external DCR leaves a scar, and it is worth being plain about that rather than glossing over it. The incision is short, placed along the natural shadow between the side of the nose and the inner corner of the eye, and closed with fine sutures. In most people it fades over months to a thin pale line that sits in a skin fold, but it does exist, and a few people heal with thicker or more noticeable scars, particularly those with darker skin tones or a personal history of raised scarring.

For some patients this is a deciding factor. People who are photographed professionally, who wear glasses with nose pads that rest exactly on that spot, or who have simply had enough of their face being a topic of conversation may lean toward the endoscopic route for the scar-free skin alone. Others shrug; a faint line beside the nose feels trivial after months of tissues in every pocket.

The scar question also connects to a second anatomical point. The incision in external DCR passes near the medial canthal tendon, the band that anchors the eyelids at the inner corner, and near small veins that can bleed briskly. Experienced surgeons place the cut to avoid those structures, and the overwhelming majority of wounds heal without any change to the eyelid position. Still, in a small number of cases the inner corner can look very slightly different afterwards, which is a reasonable thing to ask about.

Endoscopic DCR avoids all of this on the skin, at the cost of working in a tighter space with less direct access to the sac. The trade-off is real but modest, and the right answer depends on what matters more to the individual. Tell your surgeon honestly how you feel about a visible scar; it changes the conversation in a useful way (Mayo Clinic).

What happens on the day: anesthesia, time in theater, and going home

A DCR is most often performed as a day case, meaning the patient arrives, has the operation, recovers for a few hours, and goes home the same day. The operation itself is short by surgical standards, and a general anesthetic, where the patient is fully asleep, is common. Some surgeons and patients prefer local anesthesia combined with sedation, in which the nose and the area around the sac are numbed with injections and the patient is relaxed but breathing on their own. Either option is standard; the choice depends on the patient’s health, preference, and the surgeon’s practice (Mayo Clinic).

Before surgery, the nose is usually prepared with a decongestant spray or packing to shrink the lining and reduce bleeding, because the nasal mucosa is rich in blood vessels. The patient is positioned slightly head-up for the same reason. In an external DCR the skin is marked and cleaned; in an endoscopic DCR the surgeon checks the view through the nostril first.

During the operation, the sequence follows the plan described earlier: reach the bone, remove a window, open the sac, join the linings, place a stent if that is the plan. In endoscopic cases the surgeon may also trim nasal structures that would otherwise block the new opening. Some surgeons apply a short-acting medicine to the raw surfaces at the end to discourage scar tissue; whether this helps is an area of ongoing study, and its use varies.

Afterward, the patient is observed until comfortable. Nasal packing, if used, is removed either before discharge or at the first follow-up visit. Expect a lightly bloodstained nose, a feeling of fullness on that side, and, with the external approach, a dressing over the incision. Someone else should drive home. Written instructions about nose blowing, exercise, and warning signs are given before leaving, and it is worth reading them twice rather than once.

Why do surgeons leave a silicone stent, and when does it come out?

The new tunnel between sac and nose is, on the day of surgery, a raw-edged wound. Wounds want to heal closed. Left alone, the two freshly cut linings can scar across the gap and narrow or shut the very opening the surgeon created. A stent is the surgeon’s way of saying, politely, “not yet.”

The stent is a thin, soft silicone tube threaded through the upper and lower puncta, through the sac, out through the new bony window, and tied or secured inside the nose. From the outside, a patient might see a tiny loop of clear tubing sitting in the inner corner of the eye, no thicker than a strand of fishing line. It does not hurt in itself, though it can feel like having a lash at the corner of the eye for the first few days.

Stents are commonly left for a period of weeks to a few months while the lining matures around them, and are then removed in clinic in a brief, usually painless procedure where the surgeon cuts the loop and withdraws the tube through the nose (Mayo Clinic). The exact duration is the surgeon’s decision and varies with the technique used and how the tissues looked at the end of the operation.

Not every surgeon stents every case. Some evidence suggests that routine stenting adds little in straightforward primary DCRs, while others reserve it for revision operations or small sacs where the risk of closure is higher. If you have a stent, the practical rules are simple: do not rub the inner corner of the eye, do not try to pull the loop, and tell the team promptly if the loop appears to have moved outward or has prolapsed onto the eye surface. A displaced stent is an inconvenience rather than an emergency, but it should be repositioned or removed rather than left.

Dacryocystorhinostomy recovery time: what the first days and weeks look like

Recovery from a DCR is usually quieter than people expect, with the nose, not the eye, doing most of the complaining. In the first two or three days a small amount of blood-tinged discharge from the nostril on the operated side is ordinary, as is mild bruising around the inner corner of the eye after an external approach. Many people describe the sensation as a heavy cold on one side. Simple over-the-counter pain relief chosen with the team’s advice is typically enough; strong painkillers are rarely needed (Mayo Clinic).

The most important instruction in the first week or two is not to blow the nose. Blowing forces air up the new channel and can push air into the soft tissues of the eyelid, producing sudden puffiness, or disturb the clot at the surgical site and restart bleeding. Sneezing with the mouth open achieves the same pressure relief safely. Hot drinks, hot showers, bending with the head below the heart, and vigorous exercise also raise pressure in the nasal vessels and are usually paused for a short period.

Saline nasal rinses or sprays are often recommended to keep the nasal lining moist and to wash away crusts that would otherwise sit over the new opening. Antibiotic or steroid eye drops and ointments may be prescribed to the operated eye for a short course; the specifics belong to the prescribing clinician, and the course should be completed as instructed rather than stopped early because things feel fine.

Watering often continues for the first days or weeks even when the operation has gone exactly to plan, because swelling and the stent itself partly occupy the new passage. This is one of the most common sources of unnecessary worry. The true test of drainage comes later, after swelling has resolved and the stent is out. Most people return to desk work within a week or so and to unrestricted activity once the surgeon confirms healing at follow-up, typically within a few weeks (NHS).

What are the risks and complications of DCR surgery?

Every operation carries risk, and the honest list for a DCR is short but worth reading in full. Bleeding is the most frequent concern, because the nose is one of the most vascular areas of the face. Minor oozing for a day or two is expected. Heavier bleeding that does not settle with pressure and sitting upright is uncommon and may need a return to the clinic or hospital for nasal packing.

Infection of the wound or the sac can occur, usually showing as increasing redness, warmth, pain, and discharge rather than the gradual settling one would expect. Infection is treated with antibiotics chosen by the clinician and rarely affects the final result if caught early.

The operation can fail to stay open. Scar tissue can bridge the new window in the weeks after surgery, or a membrane can form over the opening inside the nose. When this happens, watering returns, and the options range from a minor endoscopic tidy-up of the opening to a full revision operation. The likelihood of this varies with the approach, the surgeon’s experience, and the patient’s healing, and your own surgeon is the right person to quote figures from their practice.

Less common risks include stent-related problems such as the loop slipping or the tube cutting into the punctum, bruising that tracks into the eyelid, temporary numbness of the skin beside the nose after an external approach, and, with the endoscopic route, injury to nearby nasal or sinus structures. Very rarely, because the sac sits only millimeters from the eye socket and the thin bone that separates the nose from the brain, surgeons describe the theoretical risk of orbital injury or cerebrospinal fluid leak; these are exceptional events that the team is trained to recognize (Mayo Clinic). Weighing this list against months or years of watering and recurrent infection is the real decision, and it is a personal one.

What are the alternatives to blocked tear duct surgery?

Not every watery eye needs a drill and a scope. The first alternative is doing nothing active while keeping the eye comfortable, which is a legitimate choice for someone whose watering is occasional and who has never had an infection. Warm compresses, gentle lid hygiene, and treating any coexisting dry eye or allergy can take the edge off reflex tearing, and some people find that enough (NHS).

For partial blockages, where saline still trickles through to the throat but slowly, less invasive procedures exist. The duct can be dilated with a tiny balloon passed down from the punctum, or a silicone stent can be threaded through the existing duct without creating any new opening, in the hope of keeping the natural pathway patent. These work best when the duct is narrowed rather than completely closed, and results tend to be less durable than a formal DCR (Mayo Clinic).

Probing, in which a fine blunt wire is passed down the duct to pop open a membrane, is highly effective in infants but rarely helps adults, whose blockages are fibrous rather than membranous (MedlinePlus).

At the other end of the scale, when both the sac and the small canals above it are scarred and a DCR cannot be connected to anything, surgeons may discuss a conjunctivodacryocystorhinostomy. In this operation a tiny glass tube, often called a Jones tube, is placed from the inner corner of the eye directly into the nose, bypassing the entire system. It needs lifelong care and occasional replacement, and is reserved for cases where nothing else can work.

Which path makes sense depends on where the blockage is, how complete it is, how much it bothers you, and what you are willing to accept in return. A good consultation walks through each of these rather than jumping to the operating room.

Why does a DCR sometimes close again, and what is a revision DCR?

The new opening is a wound inside two kinds of lining, and the body’s instinct is to heal wounds by pulling their edges together. When that instinct wins, the tunnel narrows. Surgeons call the result a failed or closed DCR, and the symptom is a return of the original watering, sometimes weeks after everything seemed settled, sometimes many months later.

Several things make closure more likely. A small bony window leaves less margin for scar to encroach on. A sac that was shrunken and scarred from repeated infection has less lining to join to the nose. Nasal anatomy that crowds the new opening, such as a septum pressed against it or a prominent turbinate, can act like a lid over the drain. Granulation tissue, the pink, bumpy tissue that forms as wounds heal, can grow over the site. And in a small proportion of cases there is simply no identifiable reason beyond individual healing (Mayo Clinic).

Revision depends on what the surgeon finds. If a thin membrane has formed over an otherwise good opening, it can often be opened with a minor endoscopic procedure in clinic or as a brief day case, sometimes with a new stent placed. If the window has filled with bone and dense scar, a formal revision DCR, usually endoscopic because the surgeon can see the nasal side of the problem directly, is performed to enlarge the opening. Revision operations are generally considered a little more demanding than primary ones, which is one reason some surgeons are more inclined to stent them.

If your watering comes back, do not assume the whole effort was wasted. Early review matters, because a membrane caught early is easier to open than a window that has fully scarred. Keep your follow-up appointments even if the eye seems fine, and report a return of symptoms promptly rather than waiting to see whether it settles.

What people often get wrong about DCR surgery and how it works

“The surgeon unblocks the tear duct.” They do not. The blocked duct is left where it is, and a new, shorter route is built above it. This is why DCR is sometimes described as a bypass rather than a clearance, and why it can succeed even when the original duct is completely sealed (Mayo Clinic).

“It is an eye operation, so the eye will hurt.” The eyeball itself is not touched. The surgery takes place in the bone and soft tissue beside the eye and inside the nose. Most of the discomfort afterwards is nasal congestion and tenderness near the bridge of the nose, not eye pain.

“Endoscopic is new and experimental.” Endonasal DCR has been performed for decades and is a standard, well-described technique. What has changed is the quality of the cameras and instruments, not the principle.

“If my eye still waters the week after surgery, it has failed.” Swelling and the stent partly block the new channel at first, so early watering is expected. The operation is judged after the stent is out and the tissues have settled.

“A watering eye always means a blocked duct.” Dry eye, lid laxity, allergies, and blocked puncta all cause watering and none of them is helped by a DCR. Testing before surgery exists precisely to avoid operating on the wrong problem (NHS).

“Babies with blocked ducts need a DCR.” Almost never. Infant blockages are usually a thin membrane that opens on its own or with simple probing (MedlinePlus).

“Once it is done, it is done forever.” Usually, yes, but the new opening can scar closed and need attention. Follow-up is part of the treatment, not an optional extra.

Questions to ask your care team before DCR surgery

A consultation goes better when the patient arrives with a short list rather than a vague worry. These are the questions that tend to produce the most useful answers, grouped loosely by theme.

On the diagnosis: Where exactly is my blockage, and how was that confirmed? Is there anything else contributing to my watering, such as eyelid position or dry eye, that should be treated first or alongside? Is there any reason to examine the sac for anything unusual during the operation?

On the approach: Do you recommend external or endoscopic DCR for me, and why? What is your own experience with each? Are there features of my nose that would make one route easier or harder? If I feel strongly about avoiding a scar, does that change your advice?

On the procedure day: Will I be asleep or awake with sedation? Will nasal packing be used, and when is it removed? Will you place a stent, and if so, when do you expect to take it out?

On recovery: What should I avoid, and for how long? When can I return to work, exercise, swimming, and flying? What drops or sprays will I need, and who do I contact if I run into trouble out of hours?

On outcomes: In your practice, how often does the opening close again, and what would we do if it did? What signs should prompt me to call you before my scheduled review?

Bring a pen, or ask whether you may record the answers. Honest teams welcome specific questions, and the answers you receive are far more relevant to your situation than any general article, including this one. The final decision about whether, when, and how to operate rests with you and your treating team together (Mayo Clinic).

When to call your doctor after DCR surgery

Most recoveries are uneventful, and a mildly blocked nose with a little blood-tinged discharge for a few days is normal. Certain changes, however, should prompt a same-day call to the surgical team or, if the team cannot be reached, a visit to urgent care or an emergency department.

Call promptly for bleeding from the nose or wound that is brisk, that soaks through dressings, or that does not stop after sitting upright and applying gentle pressure for a sustained period. Call for increasing rather than decreasing pain, redness, warmth, or swelling around the inner corner of the eye or along the incision, especially with fever or discharge that looks like pus; these can signal infection. Call for sudden puffiness of the eyelids after sneezing or nose blowing, which may indicate air tracking into the tissues and should be assessed even though it often settles.

Seek urgent assessment for any change in vision, double vision, the eye appearing pushed forward or unable to move fully, or severe pain deep behind the eye, since these could reflect bleeding or swelling within the eye socket. A persistent clear, watery drip from one nostril that tastes salty and increases when leaning forward is rare but should be reported the same day, because it can represent a leak of cerebrospinal fluid.

Also let the team know, without emergency urgency, if the silicone stent loop has slipped out onto the eye surface or seems to have pulled into the corner of the eye, if the eye becomes very sticky and red, or if watering that had improved returns and persists for more than a few days.

Written discharge instructions usually include a direct number for exactly these situations. Keep it somewhere visible, and err on the side of calling. A phone call that turns out to be unnecessary costs nothing; a complication caught late can cost the result (Mayo Clinic).

Frequently asked questions

What is DCR surgery and how does it work in simple terms?

DCR surgery, short for dacryocystorhinostomy, creates a new drainage opening between the tear sac at the inner corner of the eye and the inside of the nose. The surgeon removes a small window of bone separating the two, opens the sac, and joins the sac lining to the nasal lining so tears can bypass the blocked nasolacrimal duct below. A temporary silicone stent often holds the new channel open while it heals.

Endoscopic DCR vs external DCR: which one is better?

Neither is universally better. External DCR uses a small skin incision and gives the surgeon direct sight of the sac, which helps when something unusual needs to be inspected. Endoscopic DCR works through the nostril with a camera, avoids a facial scar, and allows nasal problems to be corrected at the same time. The choice depends on your anatomy, scar preference, previous nasal surgery, and your surgeon’s training and experience.

What is the typical dacryocystorhinostomy recovery time?

Most people are home the same day and back to desk work within about a week, with full activity usually permitted once the surgeon confirms healing at follow-up, often within a few weeks. Expect mild nasal congestion and a little blood-tinged discharge for the first few days. Nose blowing and heavy exertion are avoided early on. Watering may persist until swelling settles and the stent is removed, which is normal rather than a sign of failure.

Does DCR surgery leave a scar?

External DCR leaves a short scar beside the nose, between the inner corner of the eye and the bridge. It is placed in a natural skin fold and usually fades to a thin pale line over months, though a few people scar more visibly. Endoscopic DCR is performed entirely through the nostril and leaves no mark on the skin. If a visible scar concerns you, say so; it is a legitimate factor in choosing the approach.

Is DCR surgery painful?

The operation is performed under general anesthesia or local anesthesia with sedation, so it is not felt at the time. Afterwards, most people describe nasal congestion, tenderness near the bridge of the nose, and mild bruising with the external approach rather than true eye pain, because the eyeball itself is not touched. Simple pain relief agreed with the team is usually enough. Increasing pain rather than easing pain should be reported.

Why do I still have a watery eye after DCR surgery?

Early watering is common and expected. Swelling of the nasal and sac linings, blood clot, and the silicone stent itself all partly occupy the new channel in the first days to weeks, so drainage is incomplete even when the operation has gone well. The real test comes once swelling resolves and the stent is removed. If watering persists well beyond that point, or returns after improving, tell your surgeon so the opening can be checked.

What is the silicone tube in the corner of my eye after DCR?

It is a stent, a thin soft silicone loop threaded through the two tear openings on the eyelid edge, through the sac, and out into the nose. Its job is to keep the new drainage passage from scarring closed while the linings heal. It can feel like a lash in the corner of the eye for a few days. It is removed in clinic, usually in a brief and painless procedure, at a time your surgeon decides.

Can a DCR fail, and what happens then?

Yes, the new opening can scar closed, either early or months later, causing watering to return. Causes include a small bony window, a scarred sac, nasal anatomy crowding the opening, or individual healing. If a thin membrane has formed, it can often be reopened with a minor endoscopic procedure. Denser scarring may need a revision DCR, usually endoscopic. Reporting returning symptoms early makes any correction simpler.

What are the alternatives to blocked tear duct surgery?

Options depend on how complete the blockage is. Partial narrowing may respond to balloon dilation or a stent placed through the existing duct without creating a new opening, although results tend to be less durable than a DCR. Mild watering without infection can simply be monitored while treating dry eye or allergy. Infants are managed with massage and, if needed, probing. When the whole system is scarred, a glass bypass tube may be discussed.

Can I fly after DCR surgery?

Short flights are generally not a medical barrier once early bleeding has settled, but the exact timing should come from your surgeon, who knows how your tissues looked and whether packing or a stent is in place. Cabin pressure changes can increase nasal congestion and the urge to blow the nose, which should be avoided early on. Arrange your follow-up appointments, including stent removal, before committing to travel dates.

References

• NHS: Watering eyes
• MedlinePlus Medical Encyclopedia: Blocked tear duct

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.