Fluoroscopically guided balloon dilation in treatment of complete obstruction of the nasolacrimal system was assessed in 39 eyes of 35 patients. All patients had severe epiphora. With nasal endoscopic guidance, a 0.018-inch guide wire was introduced through the superior punctum into the inferior meatus of the nasal cavity and was pulled out through the nasal aperture with a hemostat. A deflated angioplasty balloon catheter was passed retrograde over the guide wire through the inferior meatus until it straddled the stricture. Balloons were dilated with water-soluble contrast medium. No major complications occurred. At 7 days after balloon dilation, epiphora decreased in 22 of 39 eyes; 17 demonstrated complete resolution of severe epiphora, and five showed incomplete resolution. At 2 months, improvement had not been maintained in 10 of the 22 eyes. This technique for treatment of complete obstruction of the nasolacrimal system is simple and safe, but the high failure and recurrence rates in this study are not encouraging.