Purpose <p>The lacrimal lavage test commonly assesses lacrimal obstruction but can cause discomfort. This study compares pain scores during lacrimal lavage for the first and second eye, examines differences between eyes with and without nasolacrimal duct obstruction, and evaluates lidocaine versus saline for pain relief.</p> Materials and methods <p>This cross-sectional observational study was conducted at the Ophthalmology Department of a University Hospital from October to November 2024 and included 252 eyes from 126 patients with epiphora who underwent nasolacrimal lavage. Lacrimal irrigation was performed using a 23-G blunt cannula with saline on one side and lidocaine on the other. Pain was assessed using the Visual Analog Scale (VAS).</p> Results <p>There was no significant difference (<i>p</i> = 0.26) in VAS scores between the saline and lidocaine irrigation sides. However, the VAS score for the lavage performed on the first side was significantly higher (<i>p</i> = 0.047) than the second side. Additionally, female patients reported significantly higher VAS scores compared to male patients (<i>p</i> = 0.001). In patients with dacryostenosis, the VAS score on the side with nasolacrimal duct obstruction was significantly higher (<i>p</i> = 0.008) compared to the side without NLDO.</p> Conclusion <p>This study shows that lacrimal lavage is a painful procedure for assessing the nasolacrimal duct. Lidocaine was ineffective in reducing pain, with most discomfort caused by fluid pressure. Higher pain scores were observed in obstructed ducts and during the first procedure, likely due to anxiety. Women reported greater pain than men, underscoring the need to address gender differences in pain management.</p>