Background <p>Dacryocystorhinostomy is a commonly performed procedure for nasolacrimal duct obstruction with generally favorable outcomes. However, variability in long-term success has been reported, and the role of racial and ethnic factors remains incompletely understood. This study aimed to assess differences in long-term reoperation risk following dacryocystorhinostomy across racial and ethnic groups.</p> Methods <p>A retrospective multicenter cohort study was conducted using deidentified electronic health records from a global research network (2005–2025). Adult patients undergoing primary dacryocystorhinostomy were included and categorized as White, Asian, Black or African American, or Other. Patients with congenital lacrimal anomalies or malignancy were excluded. Propensity score matching was performed in a 1:1 ratio between each non-White group and White patients, adjusting for demographic characteristics, socioeconomic factors, comorbidities, prior procedures, laboratory parameters, and visit type. Time-to-event analyses were performed using Kaplan–Meier estimation, log-rank tests, and Cox proportional hazards models. The primary outcome was time to reoperation, defined as repeat dacryocystorhinostomy occurring more than 90 days after the index procedure.</p> Results <p>After matching, 1,820 Asian, 744 Black or African American, and 629 patients in the Other group were compared with equal numbers of White patients. Reoperation occurred in 14.0% of Asian patients versus 10.4% of White patients (hazard ratio 1.32, 95% confidence interval 1.09–1.59; <i>P</i> = 0.004). In the Other group, reoperation rates were 11.9% versus 9.9% (hazard ratio 1.58, 95% confidence interval 1.13–2.22; <i>P</i> = 0.007). Among Black or African American patients, reoperation occurred in 11.2% versus 8.6% of White patients, with no statistically significant difference (hazard ratio 1.27, 95% confidence interval 0.92–1.76; <i>P</i> = 0.153).</p> Conclusions <p>Differences in long-term reoperation risk following dacryocystorhinostomy were observed across racial and ethnic groups, with higher risk in Asian and Other groups compared with matched White patients. These findings are hypothesis-generating and should be interpreted in light of the absence of data on surgical technique, operative variables and socioeconomic factors. Prospective studies capturing these variables are needed to clarify underlying mechanisms and support equitable clinical practice in lacrimal surgery.</p> Trial registration <p>Not applicable.</p> Clinical trial number <p>Not applicable.</p>