For most congenital lacrimal obstructions, lacrimal tract exploration and lacrimal intubation are usually very effective. However, there are other abnormalities that cause tear flow that can usually only be treated with a lacrimal sac rhinostomy. These children often have complex pre-surgical conditions, such as trauma or complex etiologies such as pseudomembranous conjunctivitis, which result in post-surgical ostomy failure. In children, due to their inherent histological characteristics, such as high tissue renewal and replacement activity, narrow nasal cavity, high bleeding and inflammatory exudation at the stoma, easy formation of granulation, tissue adhesions, etc., resulting in stoma failure, lacrimal sac rhinostomy in children is recommended to be performed simultaneously with silicone tube placement, which is closer to the normal anatomical structure. The results are also satisfactory (79%). The silicone tube should be left in place for more than 12 weeks after surgery, and if the child is cooperative, extubation can be done in the outpatient treatment room. We have previously learned that there are two routes to perform nasal lacrimal sac anastomosis, an external route through a skin incision and a nasal endoscopic lacrimal sac rhinostomy using the nasal endoscope. According to previous studies, the long-term results of both surgical approaches are comparable, however, for children, especially those with specific etiologies, the latter is more advantageous because, on the one hand, the transnasal route avoids leaving facial scarring, which is of self-evident significance for the future psychological development of the child; on the other hand, some etiologies of lacrimal obstruction also cause difficulties for the external route, such as trauma, which, when On the other hand, some etiologies of lacrimal obstruction also make external surgery difficult, such as trauma, which can cause lacrimal obstruction along with comorbidities such as fragmented bone fragments and collapse of the bone around the lacrimal duct, which can make external surgery impossible or unsuccessful, whereas transnasal nasal endoscopic surgery does not have these problems, but for the same reason, the surgery needs to be combined with lacrimal intubation at the same time as the successful stoma, the purpose of which is to support the lacrimal structures, maintain the patency of the stoma and avoid the growth of granulation. Because it is a combined procedure, it increases the difficulty and complexity of the surgery, and it requires experience in both external or transnasal nasal lacrimal sac anastomosis and lacrimal intubation surgery, otherwise it is very likely to fail. The ophthalmology department of Beijing Children’s Hospital has been performing lacrimal intubation surgery for many years and can perform 5 different types of lacrimal intubation surgeries, and has performed tens of thousands of lacrimal intubation surgeries in children, ranking first in the world. The ophthalmology department of Children’s Hospital has many experienced lacrimal surgery specialists, and has the world’s most advanced lacrimal speculum and nasal endoscope equipment and surgical instruments, which can perform external and transnasal lacrimal sac anastomosis surgery, while the combined lacrimal intubation surgery increases the success rate of the surgery and also minimizes the incidence of complications.