OBJECTIVE: The purpose of this study was to evaluate outcomes between nonlaser endonasal endoscopic and external dacryocystorhinostomy (DCR) in a district general hospital in the United Kingdom.STUDY DESIGN: We conducted retrospective case notes review and postal questionnaire.SUBJECTS AND METHODS: Case notes of patients who had DCR from August 2003 to August 2007 were reviewed. All patients were sent a questionnaire that included a visual analogue scale (VAS).RESULTS: Seventy patients were identified (35 external, 35 endoscopic). At discharge, 94% of external DCR patients reported being asymptomatic or improved compared with 86% for endoscopic DCR. The average VAS score for external DCR was 8.9 compared with 7.5 for endoscopic DCR (z = 2.1, P < .05). The average VAS score for external DCR was consistently higher than endoscopic DCR up to 30 months of follow-up.CONCLUSION: External DCR offers better outcomes than endoscopic DCR. Endoscopic DCR is associated with fewer reported complications. A postal questionnaire can be a good alternative method of assessing long-term outcomes rather than relying solely on protracted clinic follow-up. There are few published endoscopic DCR results from the UK, and formalized training must be introduced.