Eosinophilic angiocentric fibrosis is an unusual fibrotic condition of unknown aetiology that tends to affect the upper respiratory tract. Twenty-one cases have been reported in the literature and only three have had ocular adnexal involvement. Despite characteristic histopathological and clinical findings, the diagnosis remains a challenge. Furthermore, its progressive nature with potential to invade adjacent structures and the lack of response to current treatment modalities make management difficult. We describe a case of sinonasal eosinophilic angiocentric fibrosis that presented with bilateral nasolacrimal duct obstruction.