Varices are abnormally dilated and tortuous vessels of an existing venous structure. A female patient, 58 years of age, presented with right-sided epiphora of 5-year duration and left-sided epiphora of 1-year duration. Clinical examination revealed bilateral punctal and canalicular stenosis with right-sided primary acquired nasolacrimal duct obstruction and left-sided partial primary acquired nasolacrimal duct obstruction. There was no history of hemolacria. Lacrimal sacs were not palpable. Bilateral endoscopic dacryocystorhinostomy with bicanalicular Crawford intubation was advised. Right-sided dacryocystorhinostomy was uneventful. However, during the surgery for the left side, following osteotomy, the lacrimal sac and nasolacrimal duct walls were noted to have focal areas of grossly dilated and tortuous vessels. Their location was on the antero-inferior wall of the lacrimal sac and medial wall of the nasolacrimal duct (Fig. A). The lacrimal sac varices were more tortuous, whereas that of nasolacrimal duct (black arrow, Fig. A) were more dilated. The underlying lacrimal sac wall was bluish in color reflecting a full thickness variceal presence (Fig. B). Nasal mucosa did not show any varices. Hemostasis was achieved following sac marsupialization by compression, and a portion of the anterior sac wall was sent for histopathologic examination. Microscopic examination revealed large dilated vascular structures with the sac wall showing features of chronic inflammation (Fig. C). The vessel walls lacked gross muscular elements without any proliferative features and were dilated with a pool of red blood cells, suggestive of varices.