A 60-year-old man with untreated chronic dacryocystitis develops an acutely tender, erythematous swelling below the medial canthal tendon. Over the next week the swelling becomes fluctuant and points just inferolateral to the medial canthus. The correct description of this stage and its management is:

• A Preseptal cellulitis, managed with systemic antibiotics alone
• B Lacrimal sac mucocele, managed by syringing and probing
• C Orbital cellulitis, managed by urgent orbital decompression
• D Lacrimal abscess, managed by incision and drainage followed by later DCR ✓

Explanation

Acute dacryocystitis progresses from preseptal cellulitis to a localized collection of pus within the distended sac, the lacrimal abscess, which may point and rupture through skin forming a lacrimal fistula. A pointing fluctuant abscess needs incision and drainage with systemic antibiotics, and once inflammation settles, DCR addresses the underlying obstruction. Antibiotics alone will not drain the loculated pus, and probing during the acute phase risks spreading infection.

Reference: Khurana, Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.