The main objective of the present study was to prospectively evaluate long-term surgical success and safety in patients with nasolacrimal duct obstruction treated with a multidiode transcanalicular laser and bicanalicular silicone intubation stenting. 42 patients treated with transcanalicular laser dacryocystorhinostomy for nasolacrimal duct obstruction were prospectively enrolled. In all cases, silicone stents were inserted. Subjective outcome measure was resolution or improvement of epiphora. Objective outcome measures were patency of the lacrimal system tested with fluorescein and persistence of the nasolacrimal window visualized by nasal endoscopy. The lacrimal system was functional in 95.2% of the patients. The endocanalicular laser DCR failed in two of the 42 (4.8%) cases. External dacryocystorhinostomy was performed successfully on the failed cases. Lacrimal pump syndrome was not seen in any patient. In conclusion, endocanalicular laser dacryocystorhinostomy using a multidiode laser appears to be an effective technique in patients unresponsive to medical therapy.