The object of this operative procedure is to make a permanent opening between the lacrimal sac and the nasal cavity by means of mucous membrane flaps from these two cavities. The procedure is a modification of the Toti-West operation as carried out by Dupuy-Dutemps.1 It is frequently done by French ophthalmic surgeons. Marin Amat,2 in a recent ophthalmological journal, reported two hundred and fifty cases seen in the past five years. In the main, the procedure is indicated in cases of epiphora due to an established obstruction of the lacrimal duct. In chronic dacryocystitis, with little ectasia of the sac, no fistula and with the walls of the sac not too thickened by scar formation, it affords a good result. Contraindications include any obstruction of the puncta or canaliculi, active infection of the sac or its walls and a high deflection of the septum to the