We describe the occurrence of a permanent conjunctivodacryocystorhinostomy fistula following previous DCR surgery in a 17-year-old female with Pierre Robin Sequence, not currently reported in the literature. The importance of assessment of lacrimal anatomy, particularly in patients with congenital cranial or facial anomalies is emphasized. Video authors: Drs. Thomas Hardy, Alan McNab and Jonathan Hyer, MBBS.