To report the presentation, complications, and treatment strategies for infants with congenital dacryocystocele.We performed a retrospective chart review of all patients presenting with dacryocystoceles to Beijing Children's Hospital between 2007 and 2011.Thirty-one patients (33 eyes) were identified, presenting at a median age of 10 days of life. Twenty-four (72.72%) patients presented with cellulitis or dacryocystitis and required systemic antibiotics. Two (6.45%) patients presented with respiratory compromise. Resolution occurred with conservative treatment for 6 eyes, but 27 (81.82%) required surgical intervention. All 27 eyes received probing, and 20 (74.07%) were successful. The other 7 eyes required marsupialization of an intranasal cyst.Although congenital dacryocystoceles may resolve with conservative measures, many become infected and require systemic antibiotic treatment, and most require surgical intervention. Referral in the early neonatal period can aid in timely intervention before complications such as infection occur.