Lacrimal pathway stenoses in pediatric patients are uncommon after the age of 1 year. Various conservative treatments (massages, hot compresses, topical antibiotics, probing and intubation of the lacrimal pathways) are generally used to resolve these disorders. When non-invasive procedures fail, dacryocystorhinostomy (DCR) is indicated. While this surgical procedure has traditionally been performed by an external approach, a less-invasive endonasal technique has recently been advocated. We herein review a series of six children affected by lacrimal pathway stenosis who were treated at the Department of Pediatric Otorhinolaryngology, Spedali Civili, Brescia (Italy) between November 2000 and January 2002. All patients underwent successful transnasal endoscopic DCR and, to date, no re-stenoses have occurred. A review of the literature focusing on diagnostic work-up and different therapeutic options is also presented.