Fourteen patients who were treated for symptomatic congenital lacrimal sac fistula were retrospectively reviewed to evaluate surgical success. Excision of the fistula alone was performed on 9 patients and excision with nasolacrimal intubation on 5 patients (to our knowledge, the latter has not been previously described in the English literature). None of the 14 patients were symptomatic postoperatively during a mean follow-up of 16 months, with a range from 3 to 39 months. We conclude that dacryocystorhinostomy is usually not necessary to successfully treat symptomatic congenital lacrimal sac fistula.