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Congenital nasolacrimal duct obstruction most often resolves spontaneously or following nasolacrimal probing with or without silicone intubation. If probing and intubation fail to resolve tearing in children with nasolacrimal duct obstruction, dacryocystorhinostomy is indicated. This may be performed either externally or endonasally. An endonasal approach has the advantages of no external scarring, shorter recovery time, and preservation of the lacrimal pump with a comparable success rate to external dacryocystorhinostomy. Unique anatomical considerations when performing endonasal dacryocystorhinostomy in children include the lower insertion of the cribriform plate and smaller overall dimensions of the nasal passages. Complications of endonasal DCR include extrusion of the silicone intubation tube, synechiae or granuloma formation, and nasal vestibule abrasion.