Snapshot A 47-year-old woman presents to the emergency department with severe eye pain. Approximately 3 days ago, she experienced a hit to the face by a football. She feels a mass around her eye that is warm and painful to the touch. Physical examination demonstrates an enlarged mass over the nasolacrimal sac that is erythematous and tender to palpation. Introduction Overview inflammation of the nasolacrimal sac can be acute, chronic, or congenital login to view 5 more bullets Microbiology Staphylococcus aureus and S. epidermidis Streptococcus pyogenes and S. pneumoniae Pseudomonas aeruginosa Haemophilus influenzae Epidemiology Demographics woman > men infants and adults > 40 years of age Risk factors nasolacrimal sac obstruction female gender nasal septum deviation rhinitis Pathophysiology Obstruction of the nasolarcimal duct causes include idiopathic inflammatory stenosis of the duct trauma malignancy infection mechanical Presentation Symptoms/physical exam acute dacrocystitis acute pain, erythema, and swelling over the nasolacrimal sac login to view 3 more bullets chronic dacrocystitis tearing (most common) eye discharge Differential Chalazion differentiating factor focal, firm, and painless nodule over the eyelid Hordeolum (stye) differentiating factor focal and tender nodule over the eyelid Treatment Medical antibiotics indications login to view 2 more bullets medications login to view 2 more bullets Surgical dacryocystorhinostomy indication login to view 2 more bullets Prognosis High success rate with surgical intervention (dacrtocystorhinostomy)