Presentation
4-day history of right periorbital swelling and cellulitis associated with headache, fever, and painful eye movements. Background of ulcerative colitis on biologic treatment.
Patient Data
There is a 1.9 cm cystic lesion seen at the origin of the lacrimal sac extending into the nasolacrimal duct in keeping with acute dacryocystitis.
Case Discussion
Acute dacryocystitis most commonly presents as preseptal cellulitis. The orbital septum lies posterior to the lacrimal sac / nasolacrimal duct therefore infection localizes to the preseptal area 1. It is frequently painful with slow to improve solely with systemic antibiotic therapy often requiring incision and drainage with intra-saccular application of antibiotic 2.
It often recovers without an effect on vision, however, there are at least 7 cases reported in the literature which are complicated by permanent visual loss, therefore urgent ophthalmological assessment is advised 3.