Purpose <p>To compare the results and complications of nasolacrimal duct intubation and balloon dacryoplasty (BDCP) for the treatment of cases with recurrent epiphora following previous probing or intubation.</p> Methods <p>A retrospective study including patients with recurrent nasolacrimal duct obstruction following previous probing or intubation whether retreated with balloon dacryoplasty or bi-canalicular intubation. All procedures were performed by the same surgeon. The results were evaluated and compared using a Modified Munk classification.</p> Results <p>The study included 103 eyes of 77 patients; 53 eyes (51.5%) underwent BDCP and 50 eyes (48.5%) underwent bi-canalicular intubation. Mean age was 4.03 ± 2.71 years (range 9 months to 12 years). Most eyes (85.5%) had severe pre-operative disease (Modified Munk grades 4 and 5). Post-operative, all patients showed improvement in terms of grading according to MMC; the collective success rate of both procedures in both groups was 51.5%, 69.7%, 86.7% and 88.9% at 1 week, 1-, 3- and 6-months post-op. respectively. Subgroup analysis revealed earlier successful outcome in group B compared to group A (p-value = 0.002), yet this relationship is reversed with Group A (BDCP) having 96% success at 6 months follow-up compared to 80% in Group B (Bi-canalicular intubation) (p-value = 0.021). Baseline demographic and clinical characteristics were comparable between the two groups, with no statistically significant differences in age, sex distribution, type of previous intervention (p-value = 0.95), or pre-operative Modified Munk grades. Complications were minimal and insignificant in both groups.</p> Conclusion <p>Balloon dacryoplasty showed a 96% success rate compared to 80% success rate of intubation after 6 months follow up. Higher success rates of treatment of recurrent CNLDO epiphora is seen when the previous procedure was a simple probing.</p>