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Acquired nasolacrimal duct obstruction is a frequent cause of epiphora and recurrent dacryocystitis, leading to substantial impairment in quality of life. Endoscopic dacryocystorhinostomy using mucosal flap techniques has been advocated to enhance ostium patency and reduce failure rates. Objectives: To evaluate the success rate, complications, and factors associated with outcomes of flap-based endoscopic dacryocystorhinostomy in patients with acquired nasolacrimal duct obstruction. Methods: This prospective single-arm interventional study was conducted in the Department of Otorhinolaryngology, Shaikh Zayed Hospital, Lahore, from January to June 2025. Seventy-two adults with syringing-confirmed acquired nasolacrimal duct obstruction were enrolled through non-probability consecutive sampling. All underwent standardized endoscopic dacryocystorhinostomy using a mucosal flap technique under general anaesthesia. Results: Seventy-two patients were enrolled, with a mean age of 42.03 ± 11.36 years and a mean disease duration of 7.97 ± 2.61 months. Most patients were female (63.9%). At 3 months, functional success was 66/72 (91.7%), anatomical success 68/72 (94.4%), and overall success 66/72 (91.7%; 95% CI 83.0–96.1), with no significant associations with baseline variables (all p>0.05). Complications declined over time; 3-month rates were infection 2.8%, granulation 5.6%, synechiae 2.8%, and restenosis 5.6%. At 1 week, infection 6.9% and granulation 11.1%. Conclusions: Endoscopic dacryocystorhinostomy using a mucosal flap technique provides a high success rate with low complication frequency in acquired nasolacrimal duct obstruction and appears largely independent of baseline clinical variables.