Dacryocystocele is a rare complication of chronic dacryocystitis. We report four such cases in which epiphora and painless cystic mass located inferior to the medial canthus were manifested. Computed tomographic scanning of the orbit showed a well-demarcated low density mass in the lacrimal sac area, and extending to the nasolacrimal duct. We completely or partially excised the mass and depending on the condition of the canaliculi and puncta, performed dacryocystorhinostomy, canaliculorhinostomy, or conjunctivodacryocystorhinostomy using Jones’ tube. Operative findings revealed that the lacrimal sac and nasolacrimal duct were dilated with obliterated proximal and distal portions of the cyst. When cysts in the lacrimal sac area develop subsequent to chronic epiphora or are accompanied by punctal agenesis, differential diagnosis should consider the possibility of dacryocystocele.