목적: The aim of this study was to compare the surgical outcomes of endoscopic dacryocystorhinostomy (DCR) by two different techniques first by creating large fenestrum rhinostomy, second by creating small fenestrum rhinostomy. 방법:Design prospective randomized studySetting Tertiary academic hospital.Patients Thirty patients with distal lacrimal passage obstruction underwent primary intranasal endoscopic DCR from the period of June 2008 till March 2011. The patients were randomized into two study groups 15 cases were done with large rhinostomy and lacrimal sac opening and 15 cases were done with small rhinostomy and lacrimal sac opening.Main outcome measures Subjective Questioning the patient about presence or absence of epiphora Objective Endoscopic assessment of the rhinostomy opening, Fluorescein dye testing, presence of granulation tissue at rhinostomy site and Presence of synechiae between the middle turbinate or the septum and the rhinostomy opening. This is done after 3 and 6 months postoperatively. 결과:fifteen patients underwent large fenestrum DCR and fifteen patients underwent small fenestrum DCR. The cohorts showed no significant demographic differences between groups. At 6 months the success rate for the large fenestra group was 80% while it was 46.7% for the small fenestra group (P = 0.05). Endoscopic assessment showed positive fluorescein dye test in 73.3% at the large fenestra group and in 46.7% at the small fenestra group (p = 0.05). Visibility of the rhinostomy opening was achived in 73% of cases at the large fenestra group and it was achieved in 40% of cases at the small fenestra group (p=0.045). There were granulations at the rhinostomy opening in 6 of 15 cases (40%) at the large fenestra group while it was present in 1 of 15 cases (6.67 %) (p = 0.03) at six months postoperatively. 결론:large fenestrum DCR with removal of the whole medial wall of the lacrimal sac is efficient in treating epiphora than the small fenestrum one.