Background: Epiphora is a common disease and has many causes which may be due to obstruction along the nasolacrimal system. Inferior meatus pathology is common but inferior meatus is not routinely evaluated. So, any patient with epiphora, nasal examination is mandatory and inferior meatus must be evaluated.
Objective: Examination of the inferior meatus and nasolacrimal duct orifice in patients with epiphora, and estimation of the percentage degree of nasal causes in cases of epiphora,
Patients and Methods: This retrospective study was carried out on fifty consecutive patients who attended to outpatient clinic, Al-Azhar University Hospitals (Al-Hussein and Sayed Galal University Hospitals) between September 2019 and June 2020. They were complaining of persistent bilateral or unilateral epiphora.  All of them underwent trans-nasal endoscopic examination of inferior meatus for any lesion obstructing the opening of nasolacrimal ducts. This occurred by use of 2.8 mm 30 degree endoscope.
Results: There were 15males (30%) and 35 females (70%).The mean age of included cases were 53.16 years. Thirty two patients appeared normal (64%),10 patients with hypertrophied mucosa at  the orifice (20%).2 patients with dacryolith (4%), 2 patients with synechia obstructing the orifice (4%), 3 patients with cystic obstruction (6%), and one patient with mucosal plug at the orifice (2%). Females were mostly affected.  Most of patients were unilaterally affected and most of them had hypertrophied mucosa at the nasolacrimal orifice.
Conclusion: Inferior meatus endoscopy should be routinely performed in patients with epiphora to identify any pathology which may be easily corrected.