Three-dimensional fast spin-echo Cube (3D-FSE-Cube) uses modulated refocusing flip angles and autocalibrates two dimensional (2D)-accelerated parallel and nonlinear view ordering to produce high-quality volumetric image sets with high-spatial resolution. Furthermore, 3D-FSE-Cube with topical instillation of fluid can also be used for magnetic resonance dacryocystography (MRD) with good soft tissue contrast. The purpose of this study was to evaluate the technical quality and visualization of the lacrimal drainage system (LDS) when using the 3D-FSE-Cube sequence and the 3D fast-recovery fast spin-echo (FRFSE) sequence. In total, 75 patients with primary LDS outflow impairment or postsurgical recurrent epiphora underwent 3D-FSE-Cube MRD and 3D-FRFSE MRD at 3.0 T after topical administration of compound sodium chloride eye drops. Two radiologists graded the images from either of the two sequences in a blinded fashion, and appropriate statistical tests were used to assess differences in technical quality, visibility of ductal segments, and number of segments visualized per LDS. Obstructions were confirmed in 90 of the 150 LDSs assessed. The technical quality of 3D-FSE-Cube MRD and 3D-FRFSE MRD was statistically equivalent (P = 0.871). However, compared with 3D-FRFSE MRD, 3D-FSE-Cube MRD improved the overall visibility and the visibility of the upper drainage segments in normal and obstructed LDSs (P < 0.001). There was a corresponding increase in the number of segments visualized per LDS in both groups (P < 0.001). Compared with 3D-FRFSE MRD, 3D-FSE-Cube MRD potentially improves the visibility of the LDS.