목적: Conjunctivodacryocystorhinostomy (CDCR) is usually performed as the primary procedure for agenesis or pre-lacrimal sac obstruction (obstruction of upper and lower canaliculi and common canaliculus). Although dacryocystography (DCG) is frequently used for the assessment of the lacrimal drainage system, there is some discrepancy between physical examination and obstructive findings of DCG. This study aimed to define proper managements in patients with pre-lacrimal sac obstruction on DCG. 방법:A retrospective chart review of 25 patients (28 eyes) who underwent surgical treatment for epiphora caused by pre-lacrimal sac level obstruction on preoperative DCG and lacrimal irrigation test was performed. Eleven eyes that showed patency on lacrimal system probing were treated with endoscopic dacryocystorhinostomy (EDCR) and 5 eyes showing soft stop finding were treated with EDCR with or without CIS silicone tube insertion. And, 12 eyes with no passage on probing were treated with CDCR. Surgical outcomes were evaluated postoperatively by improvement of subjective symptoms and patency on lacrimal irrigation. 결과:Subjective symptoms improved postoperatively in 62.5% (10/16) after EDCR with or without CIS silicone tube insertion and 41.7% (5/12) after CDCR. In cases of CDCR, causes of epiphora were trauma(66.7%), iatrogenic(8.3%) and unknown etiology(25%). Revision surgery rates were higher in patients who underwent CDCR (6/7, 85.7%) than in patients who underwent EDCR (2/6, 33.3%). In cases of CDCR, revision surgery ranged from 1 to 3 times, with an average of 1.4 times. 결론:The results of the present study suggest that EDCR should be considered as the first line treatment in patients with pre-lacrimal sac obstruction on DCG, because more than half of patient with pre-lacrimal sac obstruction on DCG in this study showed patency on lacrimal system probing and CDCR is more invasive procedure with a lower success rate.