A 4-year-old boy (accompanied by his mother) presents to your office with a 5-day history of runny nose and a 2-day history of swelling in the left eye. The swelling can be localized to the inner portion of the lower eyelid, at the medial angle of the eye. There is redness and some crusting at the eyelids, and the child is fussy when you try to examine the eye. You notice that the mother is continually wiping the eye on account of excessive tearing; when you apply digital pressure to the lacrimal sac, some purulent discharge is exuded from the punctum. The child has no past ocular complications or infections and is otherwise healthy.
The most likely diagnosis is
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Acute ethmoid sinusitis
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Facial cellulitis involving the medial angle of the eye
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Dacryoadenitis
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Dacryocystitis
Answer on page 58
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