Epistaxis is a common nasal symptom seen in all age groups. It often presents as an emergency. An attempt should always be made to find any local or systemic cause for it because epistaxis is a sign and not a disease per se. Objectives: To evaluate the local causes of epistaxis using rigid nasal endoscope for specific treatment planning. Methods: This was a prospective study which included 50 patients with epistaxis who attended the Otolaryngology outpatient department of SUT Academy of Medical Sciences, Trivandrum over a period of one year. Rigid nasal endoscopy under local anesthesia was done for these patients for whom both anterior and posterior rhinoscopy could not reveal any local causes. Results: Nasal endoscopy helped in finding the local causes for epistaxis. Epistaxis was more common in males (66%) and majority was in the age group of 21-30 years (46%). The causes were posterior deviation of nasal septum with spur (24%), bleeding points on the nasal septum (12%), rhinosporidiosis (10%), infected polyp (10%), deviated nasal septum with allergic rhinitis (8%), congested adenoids (8%), deviated nasal septum with sinusitis (4%), nasopharyngeal mass (4%), and miscellaneous conditions (6%). In 6% patients, no significant local cause was detected. All the patients were treated according to the endoscopic findings. Conclusion: Nasal endoscope is an important tool in diagnosis and treatment of local causes of epistaxis.