In more severe or chronic cases, surgical intervention may be required. The most definitive surgical solution is a dacryocystorhinostomy (DCR). This procedure creates a new drainage pathway between the eye and the nose, bypassing the blocked duct entirely. Traditionally performed through an external incision, modern techniques often allow for an endoscopic approach, where the surgery is performed through the nostril. This leaves no visible scar and has a high success rate. By creating a direct connection to the nasal cavity, the DCR restores the natural flow of tears, resolving the symptoms permanently.