Background: Dacryocystorhinostomy (DCR) is among the common oculoplastic surgeries performed for managing epiphora due to nasolacrimal duct obstruction. Bleeding is one of the important complications during DCR. One of the successful approaches to reduce bleeding tendency is to apply the controlled hypotension with a mean arterial blood pressure. Other mechanism for controlling bleeding is infiltrating the incision site by local anesthetic with admixed epinephrine to promote local vasoconstriction. Aim: To compare the efficacy of combined local and general anesthesia in a group of patients undergoing external dacryocystorhinostomy (DCR) operation versus the efficacy of general anesthesia with induced hypotensive anesthesia. Methods: This prospective randomized clinical trial included 64 patients scheduled for external DCR and were divided into two equal groups, local group included 32 patients and Nitroglycerine (TNG) group included other 32 patients. Bleeding was estimated by the amount of blood loss from the surgical site by suctioning into the suction bottle.