Developments in fiberoptic technology and increasing interest in minimally invasive surgery have fueled advances in transcanalicular surgery. This article presents a review of instruments and methods for diagnostic and therapeutic approaches to adult lacrimal drainage obstruction. Available endocanalicular probes, microendoscopes, lasers, microdrills, trephines, and antegrade lacrimal balloon catheters are discussed and compared. Developments in microendoscopy, laser transcanalicular dacryocystorhinostomy, laser canaliculoplasty, transcanalicular drilling and trephination, and transcanalicular balloon dacryoplasty are also discussed in detail. Transcanalicular surgery provides a minimally invasive approach to adult lacrimal drainage obstruction that may also address the pathology causing the obstruction. Long-term success rates of transcanalicular dacryocystorhinostomy appear to be improving, but cost and a paucity of data on long-term results continue to limit the use of transcanalicular surgery.