Although optimal therapy for lacrimal sac HPCT is not established because of its rarity, treatment should follow advocated regimens for HPCT's occurrence in other locations. Total local excision is recommended. As bony invasion is unusual in orbital locations,2 stripping the periorbit usually results in complete excision. Patients should be monitored for local recurrence, which has been documented in 3 of 8 lacrimal sac tumors.10- 12 In cases of incomplete excision, local recurrence, or malignant cytologic features, ocular function should be assessed and additional surgery, radiation therapy,16 or chemotherapy17 should be considered. To date, however, no consensus exists on whether either of the latter 2 treatment modalities are effective.