Objective To systematically review the effectiveness of endoscopic dacryocystorhinostomy (En-DCR) with versus without Mitomycin C (MMC) for nasolacrimal obstruction. Methods Databases such as PubMed, EMbase, CENTRAL (Issue 12, 2012), VIP, WanFang Data, CBM and CNKI were electronically searched to collect the randomized controlled trials (RCTs) which investigated the comparison between En-DCR with and without MMC for nasolacrimal obstruction. The searched data was updated to December 31st, 2012. According to the inclusion and exclusion criteria, literature was screened, data were extracted, and the methodological quality of the included studies was also assessed. Then, meta-analysis was performed using RevMan 5.2.0 software and the quality of evidences was graded using GRADEpro 3.6 software. Results A total of 9 RCTs were included in the meta-analysis. The results of meta-analysis showed that, the recovery rate in the MMC group was significantly elevated (RR=1.13, 95%CI 1.04 to 1.22, P=0.003), the area of ostium in the MMC group was bigger at 1, 6 and 12 months than in the control group, postoperatively (MD=6.68 mm2, 95% 5.43 to 7.94, Plt;0.000 01; MD=11.61 mm2, 95%CI 4.67 to 18.55, P=0.001; MD=15.65 mm2, 95%CI 2.95 to 28.34, P=0.02), respectively, but the area of ostium in the MMC group at the third month was bigger than that in the control group (MD=8.20 mm2, 95%CI –6.67 to 23.08, P=0.28). The operative time was significantly prolonged in the MMC group (MD=10.1 min, 95%CI 8.00 to 12.20, Plt;0.000 01). Conclusion En-DCR combined with MMC could improve the recovery rate and prevent the over shrinkage of ostium area effectively due to nasolacrimal obstruction.