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PURPOSE To assess the association of congenital nasolacrimal duct obstruction (CNLDO) with mode of birth (vaginal or cesarean). METHODS This study was a prospective interventional case series of 200 consecutive cases of CNLDO presenting at a tertiary care center. Data collected include demographics, mode of delivery, elective or emergency cesarean section, primary or secondary cesarean sections, type of CNLDO (simple or complex), management, and outcomes. Statistical significance was set at a P value of less than .05. RESULTS Of the 200 consecutive patients, 97 (48.5%) were vaginal deliveries and 103 (51.5%) were cesarean sections. Of the 103 cesarean section patients, 57 (55.3%) were primary cesarean sections and the remaining were secondary cesarean sections. Based on the type of CNLDO, 172 (86%) were simple CNLDO. In general, the current study did not find any significant association between the incidence of CNLDO and mode of delivery. Among the complex CNLDO cohort (n = 28), a significant association was found with cesarean section delivery (P = .016); however, no such association was noted when the patients were analyzed with regard to their age at presentation. CONCLUSIONS The current study did not find an overall significant association between CNLDO and the mode of delivery; however, the subset of patients with complex CNLDO showed a significant association with cesarean section. [J Pediatr Ophthalmol Strabismus. 2018;55(4):266-268.].