Abstract Objective To conduct a systematic review and meta-analysis of randomized controlled trials comparing the success and complication rates among various congenital nasolacrimal duct obstruction (CNLDO) procedures, intervention times, and tubes types. Design Systematic review with quantitative meta-analysis. Methods Studies were identified by searching the PubMed, EMBASE, SCOPUS, and Cochrane databases. The comparisons between categorical variables were analyzed using the χ2 test, and the dichotomous outcomes were reported as risk ratios. The precision of the effect size was based on the 95% confidence interval. Results Seven studies published between 2007 and 2013 were included. Immediate versus observation/deferred probing had similar rates of success (82.7% vs 81.8%). Balloon dacryocystoplasty and silicone intubation had similar rates of success (79.8% vs 77.8%). Monocanalicular and bicanalicular intubation had similar rates of success (88.3% vs 88.0%). The dislocation rates for monocanalicular versus bicanalicular intubation were 8.5% and 9.8%, respectively. Conclusions Immediate and deferred probing do not differ in their success rates. No difference in success rates was observed between balloon dilation and intubation. Monocanalicular and bicanalicular intubation were similar in their success and dislocation rates. Therefore, the preference of surgeons on the treatment of CNLDO should be discussed with parents to ensure the best possible outcome.