Purpose: To evaluate the effects and limitations of lacrimal endoscopy without silicone tube intubation in patients with epiphora. Methods: We conducted a retrospective chart review of 64 eyes in 49 patients who underwent lacrimal endoscopy between May 2021 and May 2022. The clinical characteristics, irrigation test results, lacrimal endoscopic findings, and type of surgery were analyzed. Results: The mean duration of symptoms was 31.2 months, and was significantly longer in the failure group than in the success group (p = 0.043). Irrigation tests showed passage, partial obstruction, and complete obstruction in 20 (31.3%), 16 (25.0%), and 28 (43.7%) eyes, respectively. Lacrimal endoscopy showed narrowing, mucus, fibrosis, granulation, and stones in 41 (64.0%), 12 (18.8%), 6 (9.3%), 3 (4.7%), and 2 (3.1%) eyes, respectively. Following lacrimal endoscopy, 32 (50.0%) eyes each were included in the success and failure groups. Preoperative irrigation test results did not affect the success rate (p = 0.203). Silicone tube intubation and dacryocystorhinostomy were performed in 5 (7.8%) and 8 (12.5%) eyes, respectively, because the symptoms did not improve after lacrimal endoscopy. Conclusions Lacrimal endoscopy, performed without silicone tube intubation, was effective in improving symptoms and may guide the choice of surgical technique, if required.