A 69-year-old man was referred with epiphora and soft-tissue swelling in the left nasolacrimal sac region. Ipsilateral Jones 1 and 2 tests were negative. On attempting sac "wash out" via the left lower canaliculus, there was fluid reflux from the left upper canaliculus. CT revealed bony erosion of the lacrimal and frontal process of the maxillary bone by nasal polyposis. T2-weighted axial MRI demonstrated severe bilateral intranasal polyposis with those on the left pushing the lacrimal sac laterally and simulating a mucocele. Transnasal polypectomy re-established physiologic tear drainage and relieved the swelling in the region of the lacrimal fossa. This case emphasises the importance of routine nasal endoscopy as part of the assessment of the lacrimal system.