Purpose <p>To appraise the current status of endoscopic dacryocystorhinostomy (En-DCR) in the management of nasolacrimal duct obstruction (NLDO), with focus on outcomes in primary and revision settings, role of adjunctive therapies, and modifications for complex scenarios.</p> Recent Findings <p>Contemporary series demonstrate anatomical success rates of 96–99% and functional success of 90–98% for primary En-DCR, with outcomes comparable to external DCR while preserving cosmesis and enabling concurrent endoscopic management of sinonasal comorbidities. Recent meta-analyses and prospective trials have clarified the role of mitomycin-C (MMC) as a safe antifibrotic adjunct with modest efficacy gains in primary cases and meaningful benefit in revision surgeries. Similarly, emerging data support adjunctive bicanalicular stenting and balloon dacryoplasty in select scenarios.</p> Summary <p>En-DCR has evolved from an alternative technique to primary procedure for nasolacrimal duct obstructions (NLDO). Current practice pattern emphasises the importance of surgeon experience, standardised ostium size and location, integrated management of nasal comorbidities in multidisciplinary settings, and judicious application of adjuncts based on multiple factors. Remaining areas of uncertainty include the routine use of intubation, optimal mitomycin-C application protocols, and standardised management of special populations, mainly trauma and pediatric dacryocystitis.</p>