A 61-Year-Old Woman With Swelling of the Lower Eyelid

C. Robert Bernardino, MD


January 12, 2010

Clinical Presentation

A 61-year-old woman presents with a complaint of painful swelling of the left lower eyelid that has been slowly progressing for 2 weeks (Figure 1). Before the swelling, she had chronic tearing out of the left eye for more than 1 year.

Figure 1. Photo of a patient with left lower lid edema and erythema, centered around the medial canthus and spreading to the upper and lower lids and cheek.

Past medical history: Patient denies facial/nasal trauma or sinus disease in the past.

Medications: None

On ocular examination:

  • Visual acuity: 20/25 right eye, 20/40 left eye

  • Pupils: equally reactive, no afferent pupillary defect

  • Color vision: symmetric, no red desaturation

  • Visual field: Full to finger counting

  • Motility: Full, left eye, with slight discomfort on medial gaze of the left eye

External examination of the eyelids showed edema and erythema of the medial left lower eyelid.

Slit lamp examination showed trace conjunctival injection in the left eye. The remainder of the examination was unremarkable.

Diagnostic Question

What is the differential diagnosis at this juncture?

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Diagnostic Question

What might help determine the underlying pathology?

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A CT scan of the orbits (Figure 2) did reveal an enlarged lacrimal sac consistent with dacryocystitis. No associated orbital or sinus infection was found.

Figure 2. CT scan. Axial cut of a soft tissue window discloses enlargement of the left lacrimal sac, with associated preseptal inflammation. No orbital or sinus involvement is shown.

Diagnostic Question

On the basis of the studies, what is your working diagnosis now?

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Diagnostic Question

What are the treatment options for this patient?

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