Five primary epithelial lesions of the lacrimal sac representing a range of epithelial tumors are presented. The benign lesions initially presented without pain or significant mass but with epiphora and a bloody discharge. The malignant lesions presented insidiously, were large, firm masses and displayed overlying skin telangiectasis rather than the diffuse erythema of dacryocystography revealed a sac partially obstructed by a subtotal space-occupying mass in benign tumors and completely obstructed with malignant lesions.