The transnasal endoscopic approach to the nasolacrimal sac was successfully applied in 20 out of 23 operations. The patients were followed up for 4-26 months, the first 21 operations having been performed in August 1988. Twenty-one nasolacrimal sacs had primary endoscopic transnasal surgery and 2 had previous failed external operations. Five operations were revised of which 3 were still unsuccessful.