Congenital dacryocystocele (DCC) is a relatively rare anomaly that is primarily caused by distal obstruction of the nasolacrimal duct. It presents as a cystic dilatation of the lacrimal sac, with or without an associated intranasal cyst. This condition can be diagnosed prenatally, usually in the third trimester, and appears on sonography as a single, round anechoic mass in the canthal area of the eye. Despite its characteristic sonographic appearance, a DCC can sometimes be mistaken for an anterior cephalocele or frontonasal dysplasia. Most cases diagnosed in utero resolve spontaneously. However, its persistence in the neonatal period is associated with persistent epiphora and periocular infection. In these cases, probing or intranasal endoscopy can sometimes be necessary to recanalize the duct. This chapter reviews the most relevant information on fetal congenital DCC and summarizes the prenatal literature.