The authors present a meta-analysis of the use of mitomycin C (MMC) as an adjunct in dacrocystorhinostomy (DCR) surgery. Fifteen randomised control trials were included. There was a degree of heterogeneity in the surgical technique used, however, the MMC is applied to the osteotomy site intraoperatively to reduce the risk of closure. MMC at concentrations between 0.02 and 1.0mg/ml were applied for between two and 30 minutes. There was no statistically significant difference in the outcome of primary endoscopic DCR (three studies) with or without the use of MMC. There was a statistically, and clinically significant difference in the outcome of primary external DCR. The failure rate was 12.6% in the control group and 6.3% in the MMC group (nine studies). The difference in failure rate of revision endo DCR was also statistically and clinically significant dropping from 30.4% to 13.2% (three studies). The meta analysis suggests there may be a role for MMC in DCR surgery, with the current results favouring its use in primary external DCR and revision endoscopic DCR.