INTRODUCTION: Blockage of the lacrimal drainage system results in impairment of normal tear channeling into the nose. Dacryocystorhinostomy (DCR) operation, which involves fistulization of the lacrimal sac into the nasal cavity, may alleviate the symptoms. The operative approach to the sac may be external or endoscopic. In endoscopic DCR, laser, rongeur, drill, curette and chisel have been used to remove the nasal mucosa, lacrimal bone and the thick bone of the maxilla forming the anterior lacrimal crest and lacrimal sac to establish lacrimal drainage. In this study we used SUCTION cautery to remove nasal mucosa in bloodless field. METHODS: SUCTION cautery-assisted DCR was performed on 43 patients (31 female and 12 male) with chronic epiphora or dacryocystitis who underwent operation during 2002-2003 in Kashani Hospital, Isfahan. The technique involved usage of SUCTION cautery and true cut forceps for removal of mucosa and bone over the lacrimal sac. The follow-up period was 6-12 months and the patients had a mean age of 38.7 years. RESULTS: The endoscopic DCR was successful in 38 of the 43 cases (88.3%). Four cases of failure in the first operation were reevaluated in the second operation. Complete bony closure and reformed bone was observed in one of these cases. In the other three cases, adhesion of middle turbinate and rhinostoma was the cause of failure and the endoscopic technique was easily performed. DISCUSSION: Excellent patient tolerance was observed, with minimal morbidity and no major complications. As compared to the external approach, endoscopic SUCTION cautery-assisted DCR is less traumatic, less time-consuming, practical and cosmetically convenient, with minimal preoperative and postoperative complications. It also allows simultaneous correction of any intranasal disease. It requires minimal instrumentation and is a relatively easy and fast technique.