Purpose: A three-dimensional (3D) rotational angiography system was used to perform 3D dacryocystography (3DRD) as an adjunct to the conventional dacryocystography assisted by digital subtraction angiography (DSA). Methods:In 15 patients with severe epiphora, 3DRD was performed after inconclusive results from DSA-assisted dacryocystography. Results:3DRD was technically feasible and well tolerated in all 15 cases. In 5 out of 15 patients, 3DRD, in contrast to DSA-assisted dacryocystography, distinguished clearly between stenotic lesions of the canaliculi, lacrimal sac or nasolacrimal duct. In 10 cases, the simultaneous display of tear ducts and adjacent structures of the nasal cavity provided critical anatomical information for decision making between endoscopic and open dacryocystorhinostomy. Conclusions: 3DRD is technically feasible and adds important information to conventional DSA-assisted dacryocystography.