Primary extrasac orbital lymphoma presenting as nasolacrimal obstruction

Primary orbital lymphoma is an unusual cause of epiphora in the elderly population. Lymphomas that give rise to nasolacrimal duct obstruction usually arise from within the lacrimal sac. Epiphora is a common presenting complaint that may be easily disregarded as a minor debilitating symptom. This case describes a 58-year-old Caucasian man presenting with epiphora due to primary extrasac orbital lymphoma, causing external mechanical compression on the nasolacrimal duct system. Although a rare presentation, it highlights the need for a thorough examination in patients presenting with epiphora. Nasolacrimal duct obstruction could well be the initial manifestation that leads to the diagnosis of a more serious underlying systemic disease, and lymphoma needs to be included in the differential diagnosis of secondary nasolacrimal duct obstruction.