Bilateral acquired nasolacrimal duct obstruction secondary to amyloidosis in a 15-year-old

A 15-year-old boy who presented with a 1-week history of increasing erythema, edema, and tenderness of the right upper and lower eyelids was found to have acquired nasolacrimal duct obstruction (NLDO) secondary to primary amyloidosis. To our knowledge, this is the youngest case of bilateral NLDO secondary to primary amyloidosis (biopsy proven for right NLDO and presumed for left NLDO) reported in the literature. This case highlights the importance of lacrimal sac biopsy in patients with acquired NLDO of unclear etiology. Given the prevalence of the primary amyloidosis subtype in cases of ocular or adnexal amyloidosis, patients should undergo immediate workup for systemic disease.