Unmasking the Unusual: A Rare Lacrimal Sac Rhinosporidiosis Masquerading as a Diagnostic Dilemma

Rhinosporidiosis affecting the lacrimal sac often presents with localized swelling in the medial canthal region and epiphora. It is a rare granulomatous infection caused by Rhinosporidium seeberi . Most of the reported cases involve the younger age group and are associated with a history of bathing in infested stagnant water. A 70-year-old lady presented with a slow-growing, unusually large mass in the lacrimal sac area. She was from an urban area and did not give a history of bathing in ponds. She was clinically diagnosed as a lacrimal mucocele, managed with dacryocystectomy along with electrocautery intraoperatively and diagnosed as rhinosporidiosis through histopathology. This case highlights the importance of high suspicion, thorough excision, electrocautery and histopathological examination in all cases of lacrimal sac swellings. Age and classical history may not always be helpful for diagnosis. This is also unique as being one of the largest lacrimal sac swellings due to rhinosporidiosis reported in the literature.