The aim of this study was to determine the diagnostic accuracy of gadolinium-enhanced three-dimensional (3D) fast spoiled gradient-recalled (FSPGR) MR dacryocystography in patients with epiphora. Bilateral nasolacrimal systems of 19 patients suspected of having nasolacrimal canal obstruction were evaluated with MR dacryocystography. A sterile 0.9% NaCl solution containing 1:100 diluted gadolinium chelate was instilled into the bilateral conjunctival sacs of the patients. The 3D FSPGR sequence was used with 1.0-T scanner with the following parameters: TR 9.3 ms; TE 2 ms; flip angle 20; 256x224 matrix; 13- or 26-cm field of view; and 1-mm slice thickness. Seventeen patients had digital dacryocystography for comparison which we considered standard of reference. Thirty-four nasolacrimal systems were evaluated with MR and digital dacryocystography. Discrepancies between the findings of both methods were detected in 2 patients. The overall sensitivity of MR in detecting the obstruction was 100%. Magnetic resonance helped to determine the canalicular and ductal obstruction in 100% of the patients and the saccular obstruction in 80% of the patients. We conclude that 3D FSGR technique for MR dacryocystography is a reliable and noninvasive method in the evaluation of the obstruction level in the lacrimal system in patients with epiphora.