Objective: To compare outcomes between conventional external dacrocystorhinostomy (ext DCR) and endonasal laser-assisted DCR (ELADCR), Design: Prospective randomized trial. Patients: The study included 210 consecutive patients (244 eyes) referred to hospital eye and ear, nose, and throat clinics. Main Outcome Measures: Success rates and complications of ext DCR and ELADCR were compared after lacrimal ducts requiring DCR were randomly chosen and divided into 2 groups (ext DCR and ELADCR). Results: The success rate was statistically equal in both groups (92.4% for ext DCR and 94.2% for ELADCR); however, morbidity (eg, intraoperative hemorrhage and wound scar) and operation time were less in the ELADCR group. Conclusion: Preoperative patient consultation for selection of the surgical modality may help select the procedure of choice for each patient with regard to aesthetics, anesthesia, operation time, and costs.