Localized nasopharyngeal amyloidosis causing bilateral nasolacrimal duct obstruction

A 62-year-old woman with a history of localized nasopharyngeal amyloidosis presented with bilateral complete nasolacrimal duct obstruction and 2 previous episodes of right dacryocystitis. Workup for systemic involvement was negative. Pathology was confirmed at the time of previous endonasal sinus surgery, showing submucosal amorphous deposition of Congo Red-positive material with apple-green birefringence. Computed tomography revealed extensive submucosal calcifications in the head and neck region, including bilateral nasolacrimal ducts. Localized amyloidosis is rare and most commonly involves the head and neck region. There is a previously reported case of nasolacrimal obstruction secondary to amyloidosis focal only to the nasolacrimal system, but we believe this to be the first report of localized nasopharyngeal amyloidosis to involve the nasolacrimal system.