OBJECTIVE The aim of this meta-analysis is to compare the surgical results of endoscopic dacryocystorhinostomy (Endo-DCR) for chronic dacryocystitis (CD) with and without intraoperative hyaluronic acid (HA) application. METHODS An electronic literature search was performed using the PubMed, Embase, Cochrane Library, CNKI, and Wan Fang databases in April 1, 2022. Review Manager software version 5.4 was used for data synthesis and a forest plot was generated for each outcome measure. RESULTS Seven randomized control trials (RCTs), which involved 739 eyes, were included in this meta-analysis. Overall, compared with the control group, intraoperative HA application significantly enhance the success rate (odds ratio [OR] = 3.27, 95% confidence interval [CI]: 2.15-4.98, P < .00001), promote re-epithelization (OR = 2.93, 95% CI: 1.83-4.68, P < .00001), reduce granulation (OR = 0.41, 95% CI: 0.21-0.80, P = .008), and scar (OR = 0.39, 95% CI: 0.22-0.68, P = .001) formation after Endo-DCR. CONCLUSIONS Intraoperative HA application seems to be a useful adjuvant that could enhance success rate by promoting re-epithelization and inhabiting granulation and scar formation around the ostium.