There is an abundance of nonrandomized studies suggesting that endoscopic DCR with the mechanical removal of bone is a viable alternative to external DCR
Is an Endoscopic Approach Superior to External Dacryocystorhinostomy for Nasolacrimal Obstruction?
Based on the only randomized controlled trial, external DCR provides a superior outcome to endoscopic DCR with regard to symptoms at 1 year follow-up
Endoscopic, External Dacryocystorhinostomy Compared for Nasolacrimal Obstruction
Research suggests external DCR provides better outcomes after one year, but endoscopic DCR is evolving with similar outcomes