PURPOSE: To report an unusual case of multiple myeloma presenting with bilateral tearing secondary to lacrimal sac involvement. DESIGN: Observational single case report. METHODS: An 83-year-old woman presented with bilateral tearing secondary to infiltrative lesions of the lacrimal sacs. A biopsy was performed; findings confirmed the diagnosis of multiple myeloma. RESULTS: The lacrimal sac fossa lesions responded to chemotherapy and local radiation. The patient subsequently developed multiple systemic recurrences, ultimately leading to her death. CONCLUSIONS: Multiple myeloma should be included in the differential diagnosis of lacrimal sac lesions.