A 65-year-old woman comes to the office due to pain and swelling over the medial aspect of her right eye for the past 2 days. Examination of the eye reveals tenderness, edema, and redness over the medial canthus. Slight pressure over the area causes expression of purulent material. Visual acuity is normal. What is the most likely diagnosis?

Question

A 65-year-old woman comes to the office due to pain and swelling over the medial aspect of her right eye for the past 2 days.  Examination of the eye reveals tenderness, edema, and redness over the medial canthus.  Slight pressure over the area causes expression of purulent material.  Visual acuity is normal.  What is the most likely diagnosis?

Quizplus · Accepted Answer

Dacryocystitis is an infection of the lacrimal sac. It usually occurs in infants and adults over the age of 40. Acute dacryocystitis is characterized by the sudden onset of pain and redness in the medial canthal region. Sometimes, a purulent discharge is noted from the punctum. A few patients present with fever, prostration, and an elevated leukocyte count. Staphylococcus aureus and beta-hemolytic Streptococcus are the usual infecting organisms. It usually responds to systemic antibiotic therapy. (Choice A) Episcleritis refers to inflammation or infection of the episcleral tissue between the conjunctiva and sclera. Patients complain of an acute onset of mild to moderate discomfort, photophobia, and watery discharge. Examination reveals diffuse or localized bulbar conjunctival injection. (Choice C) Hordeolum refers to an abscess located over the upper or lower eyelid. It is usually caused by Staphylococcus aureus. It appears as a localized, red, tender swelling over the eyelid. (Choice D) Chalazion presents as lid discomfort. It is a chronic, granulomatous inflammation of the meibomian gland. It appears as a hard, painless lid nodule. (Choice E) Orbital cellulitis refers to an infection posterior to the orbital septum. It is unilateral and more common in children. It is manifested by an abrupt onset of fever, proptosis, restriction of extraocular movements and swollen, red eyelids. Educational objective: Dacryocystitis presents with inflammatory changes in the medial canthal region of the eye. Staphylococcus aureus and beta-hemolytic Streptococcus are the usual infecting organisms.

A 65-Year-Old Woman Comes to the Office Due to Pain