Conventional dacryocystorhinostomy (DCR) usually involves extensive re
moval of bone at the lacrimal fossa and hence risks disruption of the
lacrimal pump mechanism. A physiological operation for nasal lacrimal
blockage is described whereby only the inferior portion of the lacrima
l sac and the adjacent duct are marsupialized into the nose. The opera
tion is safe, quick and does not involve sophisticated instruments. Re
sult of 81 consecutive endoscopic inferior DCRs reveals a success rate
of over 90% which is maintained with time. Most patients had a wide l
acrimal window with preserved lacrimal pump movement at the superior s
ac remnant.