Ultrasound can be used routinely in the diagnosis of lacrimal sac diseases and its surrounding tissue such as lacrimal pump mechanism, pre and postsurgical, congenital anomalies, obstruction with detection the cause of obstruction as lacrimal sac concretion, inflammations, and neoplasms. Ultrasound provides helpful additional information that influences the strategy and outcome of lacrimal sac surgery. The advantages of ultrasonographic examination of the lacrimal sac are that it is simple, quick, and inexpensive. It can be used postoperatively immediately, the patient is not exposed to radiation, it can be used without any contrast medium, and it is useful when the common canaliculus is occluded.