A syndrome of the typical patient with a dacryolith in the lacrimal sac or nasolacrimal duct is described, based on review of 107 consecutive patients undergoing dacryocystorhinostomy (DCR) and 43 patients with a history of dacryocystitis. The incidence of dacryolithiasis was 14% of all patients having a DCR. The typical patient with a dacryolith was 45 years old, had a 4.8 year history of intermittent epiphora, had at least one episode of acute dacryocystitis, and could be irrigated with some fluid getting into the nasopharynx. Patients undergoing DCR with a history of acute dacryocystitis had a nine times higher likelihood of having a dacryolith than DCR patients without a history of acute dacryocystitis. DCR was curative in all 15 patients with a dacryolith.