The standard surgical procedure for nasolacrimal outflow tract obstruction is dacryocystorhinostomy (DCR) in which the lacrimal sac is connected directly to the nose to allow drainage of tears. This technique is currently used by both ophthalmologists and ENT surgeons. The advantages of endoscopic DCR include avoidance of external scar formation, preservation of the pump mechanism of orbicularis muscle, improved hemostasis, and decreased postoperative discomfort. The endoscopic procedure allows the surgeon to correct paranasal sinusitis, septal deviations, or other nasal abnormalities. The primary causes of lacrimal pathway obstruction include acute or chronic inflammation, trauma, or congenital malformations. Patients generally present with epiphora, eyelid and lacrimal sac swelling, purulent secretion, blurred vision, and facial pain. Dacryocystitis and recurrent conjunctivitis are typical. A very detailed work-up is presented to evaluate the correct indications for DCR and to exclude patients affect by canalicula obstruction or pump defect. Surgical indications, technique, and follow-up are discussed. Relevant patient cases will be discussed to highlight the key clinical points.