Visual Diagnosis

Case: A 9-year-old boy presents with swelling to the left upper eyelid for 2 days. He had mild fever, but no eye discharge.

Diagnosis:

This patient has dacryocystitis.

Dacryocystitis is an infection of the lacrimal sac due to nasolacrimal duct obstruction. Acute dacryocystitis may present with sudden onset of pain, swelling, and erythema. A common bacterial cause is Staphylococcus aureus that may be treated with oral antibiotics.  If left untreated, the infection may develop into orbital cellulitis, periorbital edema, and corneal ulceration.

Clinical Practice Pearls:

• Consider performing a CT scan if there is suspicion of a foreign body or mass obstructing the nasolacrimal duct.
• Warm compress may assist in resolution of infection.
• For chronic dacryocystitis, consider using a topic steroid.

Futher Reading:

• Pinar-Sueiro S, Sota M, et al. Dacryocystitis: Systematic Approach to Diagnosis and Therapy.   Curr Infect Dis Rep. 2012(14):137-146.