Twenty-two patients with severe epiphora due to relative (n = 13) or absolute (n = 9) stenoses of the nasolacrimal duct were treated by means of radiologically guided balloon dacryocystoplasty. The recanalization was performed with a steerable microguide wire with flexible tip, which was advanced through the lacrimal draining system and manipulated out of the nasal cavity. A 3-mm PTA balloon was then introduced from the nasal site. In 20 of 22 cases the procedure was technically successful. Dacryocystography proved a normal lumen in 9 of 20 patients and an improvement without impairment of flow in another 8 cases. Two months after dilation a clear regression of epiphora could be demonstrated in 17 of 20 patients. The procedure was complicated by the occurrence of 2 reobstructions within the first 3 months; other serious side effects were not observed.