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Endonasal endoscopic dacryocystorhinostomy for a primaray dacryocystocele in an adult. A dacryocystocele refers to a sterile cystic dilatation of the lacrimal sac resulting from a complete obstruction of the lacrimal pathway above and below the lacrimal sac. In most cases, it is a congenital disorder that typically occurs in neonates. It is characterized by a bluish cystic swelling just below the medial canthus accompanied by epiphora. In some cases, there is also an intranasal expansion beneath the inferior turbinate. When this expansion is large and bilateral, it can lead to respiratory distress in neonates since they are obligate nasal breathers. Although congenital dacryocystoceles may resolve with conservative measures, many become infected and require systemic antibiotic treatment, and most require early surgical intervention. Herein, the authors report a rare case of dacryocystocele in an adult that was successfully managed with an endonasal endoscopic dacryocystorhinostomy. The pre-operative images and the intra-operative findings are shown, and the available literature is reviewed.