Tumours of the naso-lacrimal apparatus are rare. Benign symptoms can harbour the possibility of a neoplasm in patients presenting with lacrimal outflow obstruction resulting in misdiagnosis. Tumours are usually unilateral and more common in middle-aged males. Management of theses lesions is by joint Multi-Disciplinary Team. Surgical management includes lateral rhinotomy with en-bloc excision, orbital exenteration and even craniofacial resection. History and clinical findings are imperative in prompt diagnosis and management. We review the embryology, anatomy, tumour types and surgical approaches to these tumours from an ENT perspective.