Differential Diagnosis for the Patient's Condition

The patient presents with a 2-week history of left eye watering, worsening over the last 2 days, accompanied by redness, tenderness to touch, increased watering, pain upon touch, and redness along the cheek and nose line. Based on these symptoms, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Acute Dacryocystitis: This condition, an infection of the lacrimal sac, is likely given the patient's symptoms of eye watering, redness, tenderness, and pain, especially with the worsening condition over the last 2 days. The location of the redness along the cheek and nose line also supports this diagnosis, as the lacrimal sac is located in this area.

• Other Likely Diagnoses

  • Conjunctivitis: This could be a cause of the patient's symptoms, especially if the conjunctivitis is severe or if there is a significant amount of discharge. However, the tenderness to touch and the specific location of the redness might suggest a deeper infection like dacryocystitis.
  • Blepharitis: Inflammation of the eyelids could cause some of the patient's symptoms, such as redness and watering. However, the severity of the symptoms and the specific location of the pain and redness might indicate a more serious condition.
  • Sinusitis: Given the location of the pain and redness along the nose line, sinusitis could be considered, especially if there are other symptoms like nasal congestion or headache. However, the primary complaint of eye watering and the localized tenderness might point more towards an eye condition.

• Do Not Miss Diagnoses

  • Orbital Cellulitis: Although less likely, this condition is a serious infection of the tissues surrounding the eye and could present with similar symptoms. It requires prompt treatment to prevent serious complications, including vision loss.
  • Endophthalmitis: This is a severe inflammation of the interior of the eye, usually caused by infection. While it might not initially present with all the symptoms described, it is a critical condition that could result from trauma, surgery, or bloodstream infection and must be considered in the differential diagnosis due to its potential for severe vision loss.

• Rare Diagnoses

  • Lacrimal Gland Tumor: Although rare, tumors of the lacrimal gland could cause localized pain, redness, and possibly affect tear drainage, leading to watering of the eye.
  • Idiopathic Orbital Inflammatory Disease: This condition involves inflammation of the orbit without an identifiable cause and could present with a variety of symptoms, including pain, redness, and swelling around the eye. It is less common and might be considered if other diagnoses are ruled out.