PURPOSE: To report, for the first time, proximal canalicular obstruction in all four canaliculi of a patient with lichen planus. METHODS: The patient file and examination findings were reviewed, along with relevant literature on lichen planus and the eye. RESULTS: A 67-year-old woman with lichen planus had bilateral epiphora. All four canaliculi were totally obstructed within 2-3 mm of the puncta, and there was mild medial subconjunctival scarring. CONCLUSIONS: Lichen planus is an immune-mediated skin and mucosal disease similar to pemphigoid and lacrimal canalicular obstruction may occur as part of the disease.