AIM:To investigate the feasibility of endoscopic endonasal dacryocyst-nasal drainage combined with lacrimal passage reconstruction for the treatment of acute dacryocystitis. METHODS:All 156 patients with unilateral acute dacryocystitis, who were treated with endoscopic endonasal dacryocyst-nasal drainage combined with lacrimal passage reconstruction were retrospected. Preoperative and postoperative routine systemic antibiotics was used to control infection. RESULTS:The patients were followed up for 6-18 months, complete data were acquired from 147 patients. The acute inflammations were resolved within 2 days after operation in all patients, with no abnormal findings in the routine blood test before being discharged. The lacrimal passages were successfully reconstructed in 145 patients, failed in 2 patients. CONCLUSION:Endoscopic endonasal dacryocyst-nasal drainage combined with lacrimal passage reconstruction seems to be an effective and safe management for the primary treatment of acute dacryocystitis.