A microsurgical extranasal dacryocystorhinostomy, incorporating the lacrimal sac into the nasal cavity by creating a flap of the lacrimal sac mucosa and suturing it to the nasal mucosa is described. The results from 81 patients (84 eyes) with chronic epiphora operated during the period of 11 years from 1980 to 1991 are described and analyzed. The long term results on 84 eyes with a median observation time of five years demonstrated good stability of the primary results. Only one patient (2%) with distal tear duct stenosis had chronic epiphora at the re-evaluation.