Aim Evaluation of external dacryocystorhinostomy surgery in patients with nasolacrimal canal obstruction and the effects of the incision type on the functional and esthetic outcomes. Material and Methods Outcomes of 49 patients who underwent external dacryocystorhinostomy and bicanalicular silicon tube intubation(when necessary) for nasolacrimal canal obstruction between 2004 and 2008 were evaluated retrospectively. The effects of oblique incision, used between 2004-2005, and the vertical incision, used between 2006-2008, on the functional and cosmetic outcomes were evaluated. The patients were asked to complete a survey on preoperative symptoms, functional outcomes of the operation, and the patient satisfaction with the scar tissue and cosmetic outcomes. The results were compared statistically. Results Mean age of the 49 patients (35 females and 14 males) was 42.63±15.57 (19-72). Except for the 2 patients operated in other centers, first operations of 47 patients were performed in our clinic. Five patients required revision surgery due to functional failure. Jones’ tube implantation was performed in 1 of the 3 patients with persistant epiphora. No serious complications were observed postoperatively, except for mild nasal hemorrhage. Three patients, (2 of witch had persistent epiphora), were not satisfied with the surgery. Silicon intubation was performed to 21 patients during surgery. Outcomes were satisfactory in 46 patients. In each of the 2 incision groups, 7 patients had noticeable scars but they were satisfied esthetically. It was observed that the type of incision used, either oblique or vertical, had no effect on the functional outcome of surgery. On the contrary, it was determined that vertical incision yielded better cosmetic outcomes. Conclusion External dacryocystorhinostomy is a successful surgery for patients with nasolacrimal canal obstruction. Incision type does not affect the functional outcomes of the surgery but it does affect the cosmetic outcomes.