External versus endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction: outcomes from a Mexican tertiary eye hospital

Purpose: To compare surgical outcomes and complications of external versus endoscopic dacryocystorhinostomy (DCR) in patients with acquired nasolacrimal duct obstruction (ANDO) treated at a tertiary referral eye hospital in Mexico. Methods We conducted a retrospective, single-center, comparative study of patients undergoing external or endoscopic DCR treated between January 2019 and December 2024. Surgical success was defined as resolution or improvement of epiphora with a patent lacrimal irrigation at 6-month follow-up. Demographic variables, comorbidities, surgical technique, and complications were recorded and analyzed using Welch’s t-test and Fisher’s exact test. Results A total of 255 patients were included (mean age: 40 years in the endoscopic group, 57 years in the external group; p = 0.005). Female predominance was observed in both groups. Success rates were 100% for both techniques on day 1, and remained above 95% at 3 months. At 6 months, success was 95.7% for endoscopic DCR and 92.2% for external DCR; no statistically significant difference was found (p > 0.05). Complication rates were low in both groups (4.2% in endoscopic vs. 2.2% in external), mainly tube extrusion and local infection. No risk factors for failure were identified. Conclusions Both external and endoscopic DCR achieved high and comparable success rates with few complications in this large single-center cohort. These findings support the use of both techniques and provide valuable data from Latin America to complement global evidence on the surgical management of ANDO.