Dacryocystorhinostomy (DCR) often has uncertain results in the pediatric age group. Poorly defined and rapidly changing anatomy, along with a tendency toward vigorous growth of scar tissue, may alter surgical results. We report our experience with 29 primary pediatric dacryocystorhinostomies and five reoperations. Strict attention to surgical anatomy allows attainment of success results (83%) comparable with those in adults in both traumatic and nontraumatic cases. Our results, surgical technique, and evaluation of failures are discussed. Meticulous suturing of anterior and posterior flaps is not necessary for good surgical results. Dacryocystorhinostomy is a successful therapeutic modality in childhood dacryostenosis with chronic dacryocystitis when medical therapy, probing, and silicone intubation have been unsuccessful.