Introduction: Nasolacrimal duct obstruction (NLDO) is the most common cause of childhood epiphora. Congenital NLDO is usually conservatively management in the first year of life, failing which surgical interventions such as syringing and probing (S&P), insertion of stents (intubation) or dacryocystorhinostomy (DCR) are offered in a stepwise manner. Methods: This is a retrospective study at a tertiary paediatric hospital. Nasolacrimal surgeries were retrieved from Hospital Episodes Statistics (HES) data for a 5-year period between May 2017 to April 2022. Retrospective case note review was undertaken looking into demographics, presentation, surgical interventions, and outcomes (resolved, partially resolved or persistent). Results: In our institution, NLDO surgeries are performed on a joint ophthalmology/ENT list. A total of 301 procedures were performed on 218 patients (293 eyes). Causes for epiphora were Congenital NLDO (n=193, 88.5%), Secondary NLDO (n=10, 4.6%), Dacryocystitis/Mucocele (n=8, 3.67%) among others. Median age at first procedure was 26 months (range 2-189). Median number of procedures for congenital NLDO is 1(range 1-5). Complete resolution of symptoms was achieved by syringing and probing in 133 cases (73%), intubation in 23 cases (78%) and DCR in 7 cases(58.3%). Patients with craniofacial syndromes required a statistically significant higher number of DCRs. Overall, epiphora was completed resolved in 81% cases, 6.3% partially resolved and is persistent in 12.7%. Conclusion: Multi-disciplinary approach to NLDO ensured efficient delivery of care by minimising number of procedures and hospital attendance. Congenital NLDO can be successfully treated in vast majority of cases with S&P and intubation. In cases with anatomical abnormalities, DCR should be considered early.