Congenital lacrimal sac mucocele occurs in approximately 3% of infants with congenital lacrimal duct obstruction. Lacrimal sac mucocele is sometimes associated with a intranasal nasolacrimal duct cyst presenting as an intranasal cystic mass, which needs the involvement of an ophthalmologist and otolaryngologist in diagnosis and management. Bilateral cysts may cause in the early neonatal varying degrees of nasal obstruction, sleep disturbance, feeding difficulty and even respiratory distress. We present a case of bilateral dacryocystocoele with intranasal extension presenting as respiratory distress in a 7-day-old male newborn. The diagnosis was confirmed clinically and by computed tomography scan.