In this presentation from the 2012 Annual Meeting, Dr. Michael Hawes discusses why external dacryocystorhinostomy (DCR) provides the best results in most cases of nasolacrimal duct (NLD) obstruction. He reviews 4 past studies (Jones 1976, Welham 1987, Woog 2001, and Rose 2004) and a recent study in cadavers that compares the anatomic differences between endonasal and external DCR. He then presents the advantages of external DCR over endonasal DCR, covering exposure of lacrimal drainage anatomy, canalicular obstructions, higher and longer success rates, resection of the anterior ethmoid air cells, mucosal-lined fistula, and postoperative care.