OBJECTIVES: To calculate the costs of canalicular laceration (CL) repair at a tertiary academic eye care center based on setting and surgeon type. METHODS: A retrospective review of hospital records over a 10-year span of all primary CL repairs performed at a tertiary eye institution. Input variables included repair setting (minor procedure room; MPR vs. operating room; OR), surgeon type (oculoplastic surgeon, ophthalmologist, fellow, or resident), stent type (mini-Monoka vs. Crawford), and success rate (no epiphora/tearing down face, even with environmental stressors, at >3 months after stent removal).  Procedure-level data were used to inform probabilities in a decision analytic model (TreeAge Pro). Costs inputs included supplies (institution acquisition prices for drugs and disposable equipment) and personnel (institution wages + 30% fringe benefits for surgeon, nurse, nurse anesthetist, anesthesiologist, and scheduler). Output of the model was cost per successful repair. Univariate sensitivity analyses were performed to test the impact of modifying base case inputs ± SD. RESULTS: The estimated cost per procedure was $US323 in the MPR and $US589 in the OR. The overall success rate in the MPR was 37%, vs. 88% in the OR (p<0.0001). The ICER revealed the incremental cost of performing CL repair in the OR per success to be $521.56.  Within each setting, cost effectiveness of oculoplastic surgeons dominated vs. the other surgeon types. Sensitivity analyses revealed OR costs to be most sensitive to nurse anesthetist and nurse time, whereas MPR costs were most sensitive to ophthalmologist and nurse time. CONCLUSIONS: While it was more costly to perform CL repair in the OR, success rates were much higher. In addition, success rates were optimal when performed by oculoplastic surgeons, suggesting that sub-specialty training maximizes patient outcome. Findings are limited to a single institution but call to question whether this procedure should be performed in a MPR.