Lacrimal gland inflammation is commonly due to viral infection, autoimmune, and idiopathic inflammatory disease. Orbital and adnexal tuberculosis (OTB) is a rare entity even in the TB endemic country of India. TB dacryoadenitis is one of the presentations in the OTB spectrum, with less than 25 cases in the literature. We report the case of a 14-year-old female primarily presented with unilateral dacryoadenitis and cold abscess at the lower lumbar region. Biopsy of lacrimal gland confirmed on histopathology as tuberculosis. Systemic investigation revealed pulmonary and extrapulmonary TB. She was treated with systemic category I anti-tubercular treatment resulting in complete regression of disease.