This is a retrospective study of patients with acute dacryocystic retention (ADR). The condition is distinct from infectious dacryocystitis, and is characterised by an acute onset of pain and epiphora associated with a tender but not inflamed lacrimal sac thought to be due to a dacrylolith within the sac or duct. On reviewing 1593 patients with nasolacrimal duct obstruction, 20 were found clinically to have ADR, although 85 in total had dacryoliths at surgery. The ADR patients were significantly younger by an average of 19 years than the non-ADR patients with nasolacrimal duct obstruction. They were also more likely to be female (80%) and 30% reported passing a stone into the mouth or nose. Of the 20 with clinical ADR, 14 underwent dacryocystorhinostomy (DCR) surgery and dacryoliths were identified in nine of these peroperatively. No patient experienced a recurrent attack of ADR after DCR surgery. The authors make a clear distinction between ADR and the more common acute dacryocystitis, and stress the need to correctly diagnose ADR to avoid unnecessary and ineffective antibiotics. They recommend a DCR as the definitive treatment for recurrent ADR. The paper gives a good description of this relatively uncommon condition.