Dacryocystitis

A 38-year-old man with a history of chronic epiphora and recurrent episodes of medial canthal swelling over the past 2 years presents with acute onset of fever (38.5°C), severe pain over the medial canthus, and purulent discharge. He has already completed two courses of oral antibiotics in the past 6 months without sustained relief. On examination, there is a tender, fluctuant mass medial to the medial canthus, and gentle pressure expresses pus from the lacrimal punctum. What is the most appropriate next step in management?

A 52-year-old woman presents with a 3-week history of purulent discharge from the left eye, persistent epiphora, and swelling below the medial canthus. On examination, there is a tender, erythematous swelling over the lacrimal sac region. Pressure over the lacrimal sac elicits purulent material from the lacrimal punctum. The patient denies recent trauma or systemic illness. What is the most likely diagnosis?

A 68-year-old man with a 2-month history of left-sided epiphora and mucoid discharge presents with recurrent episodes of swelling and tenderness below the medial canthus. He has had three separate acute exacerbations in the past 6 weeks, each responding to oral antibiotics and warm compresses. On examination, a firm, non-tender mass is palpable below the medial canthus. Lacrimal sac pressure test expresses mucopurulent material. What is the most appropriate next step in management?

Which organism is the most common causative agent of acute dacryocystitis in adults?

A 68-year-old man with a history of chronic epiphora and recurrent bouts of medial canthal swelling presents with acute onset fever (38.5°C), severe pain over the medial canthus, and inability to open the left eye due to periorbital edema. On examination, there is a fluctuant mass below the medial canthus with overlying skin erythema and cellulitis extending to the upper eyelid. Vision is normal and extraocular movements are intact. Which of the following is the most appropriate immediate management?