The authors present a case of a newborn with bilateral dacryocystocele in whom repeated probing was unsuccessful. An associated intranasal cyst was diagnosed. Using fiberoptic nasal endoscopy, treatment consisted of probing, irrigation and marsupialization of the cyst. This rarely reported anomaly is a more common finding in dacryocystocele than previously recognized. Careful nasal examination in all infants with congenital dacryocystocele is recommended.