PURPOSE The study presents a case of bilateral lacrimal gland hypertrophy with secondary glaucoma due to the increased episcleral venous pressure. METHOD The case was investigated by means of clinical methods associated with ultrasound (A and B-scan, Doppler-ultrasound) and magnetic resonance imaging techniques. RESULTS The clinical data revealed proptosis, episcleral congestion, and elevated intraocular pressure. An abnormal Schirmer test and xerophthalmia were also present. Ultrasound examination identifies enlarged masses in the bilateral lacrimal fossa, supra-temporal to the globe, mostly on the left side, having a cystic structure. The Doppler ultrasound investigation revealed the vascularisation, and the magnetic resonance imaging completed the dates offered by the ultrasound methods. According to the clinical aspect and the possible visual impairment produced by the secondary glaucoma, the mass lesion was removed on the left side by neurosurgical approach. The histopathological exam confirmed the destruction of the lacrimal gland, and, furthermore, the immunohistochemical study revealed the aspect of Sjögren syndrome lesions. CONCLUSIONS Sonography is able to provide noninvasively much of the information needed by the clinician. Ultrasound techniques (A-scan, B-scan and color Doppler) and magnetic resonance imaging allow tracking and discrimination of the orbital diseases, such as lacrimal gland lesions. Associated with the clinical features, these methods offer the basis of a correct diagnosis and a proper therapy for lacrimal gland pathology.