Acute Dacryocystitis- A 4-week-old boy was brought to the emergency department after having drainage from both eyes for 2 days and redness and swelling under his left eye for 1 day...Physical examination revealed a temperature of 38.2°C, purulent drainage from both eyes, and a 1-cm erythematous, fluctuant mass inferior to the medial canthus of the left eye. The white-cell count was 14,000 per cubic millimeter (reference range, 7500 to 15,500). He received a diagnosis of acute dacryocystitis — infection of the nasolacrimal sac — resulting from congenital nasolacrimal duct obstruction. In rare instances, acute dacryocystitis can progress to orbital cellulitis, abscess, and meningitis. The patient received intravenous antibiotic agents, and the fever and eye drainage resolved after the first day of treatment. Culture of a specimen of the drainage fluid grew methicillin-sensitive Staphylococcus aureus. Cultures of urine, blood, and cerebrospinal fluid were negative... #NEJM #clinical #photo #peds #acute #dacryocystitis #ophth #nasolacrimal #duct