Recurrent epiphora after external dacryocystorhinostomy (DCR) can be a frustrating experience for both the patient and the physician. We present the results of a retrospective study of 18 patients with epiphora recurring after external DCR who were operated upon to recreate lacrimal drainage through an endoscopic endonasal approach. The procedure was successful in 83.3% of cases, with no major complications. The results are comparable to those of an external approach, but the cosmetic advantages are clear. It is a 1-stage procedure that permits correction of associated intranasal disease that may be a causative factor in the recurrence of lacrimal obstruction. The endoscopic endonasal approach is a relatively safe and reliable option in the management of recurrent epiphora.