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A 23-year-old woman presented with clinical symptoms suggestive of acute dacryocystitis. She had no history of epiphora, and her lacrimal drainage system was patent on irrigation. CT findings were consistent with anterior ethmoiditis and maxillary sinusitis. Although the symptoms responded to antibiotic treatment, they recurred 2 times within the following 5 months. During the last episode, a complete obstruction of the nasolacrimal duct developed. The condition did not recur after external dacryocystorhinostomy and anterior ethmoidectomy during a follow-up of 21 months. Ethmoiditis may rarely cause a localized infection in the lacrimal sac region mimicking dacryocystitis. Recurrent infections may progress to complete obstruction of the nasolacrimal duct.