Macrodacryocystography, when combined with bilateral canaliculus intubation gives simultaneous distension of the duct system and better contrast filling. As a result there is improved radiographic visualization of the exact site of pathology, particularly an obstruction. This important information makes it easier to chose the correct surgical technique to relieve epiphora. In addition, other pathology such as diverticula and fistula may be visualized. Subtraction may be a useful adjunct to the method. After a description of the normal anatomy of the lacrimal system, the technique is explained and the results of 52 examinations given.