It has always been the teaching that recurrent unilateral conjunctivitis must be evaluated for partial or complete nasal lacrimal duct obstruction. This may be congenital or acquired. In the adult population, women are more commonly involved than men, with an average age range of 50 to 70 years. This may be caused by a narrower nasal lacrimal duct system than in men or postmenopausal hormonal changes on the mucosa. The diagnosis is made by observing discharge or epiphora, pressing on the lacrimal sac fossa to see if the lacrimal sac is enlarged or painful. If discharge on pressure emanates from either punctum, the diagnosis is made of nasal lacrimal duct obstruction, with the blockage distal to the lacrimal sac. Otherwise, it is necessary to gently irrigate the lacrimal system, looking for reflux from the lower system to the upper system, with little to no irrigant going down the nasal lacrimal duct. A DCR is highly successful in resolving the problem.