Since Toti's original discription of dacryocystorhinostomy in 1904, most surgery for relief of lacrimal obstruction has been performed through a skin incision by ophthalmologist. With improved intranasal visualization with the endoscope, allowing easy identification and opening of lacrimal sac, dacryocystorhinostomy has become a new field in otorhinolaryngology. Sixty-nine patients complaining of Epiphora have undergone endoscopic laser dacryocystorhinostomy at our department since March, 1992. Limited tissue injury, eliminated cutaneous scar, excellent hemostasis, and increased cost-effectiveness are the advantages of endoscopic laser dacryocystorhinostomy over the standard external approach. Endoscopic laser dacryocystorhinostomy appears to be a safe, effective treatment for the difficult patients who manifest lacrimal obstruction.