Congenital dacryocystoceles presenting with intranasal extension may precipitate respiratory distress in neonates. Twenty-one children have been described as having congenital dacryocystoceles with intranasal extension, and, of these, 14 had respiratory distress. We present a series of patients with congenital dacryocstoceles who presented with ranging degrees of respiratory distress. Magnetic resonance maging and computed tomographic scans confirmed the diagnosis. In all cases, the endonasal portion of the cryst was marsupialized endoscopically with complete resolution of symptoms. Pertinent embryology, anatomy, clinical presentation, and treatment are discussed.