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We read with interest “Prospective randomised comparison of external dacryocystorhinostomy with and without silicone intubation” by Saiju et al.1 The investigators should be congratulated on their effort in performing a prospective clinical trial to address this important question. There are, however, issues that we believe limit the ability to draw definitive conclusions from their study. First, we have concerns about the randomisation process at the time of surgery scheduling that resulted in unbalanced treatment groups because of early withdrawal. This process of patient self-selection can result in unidentified differences between treatment groups that may have affected their results. Second, a χ …