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. Despite using hot and cold packs, there has been no relief from symptoms.

• Single Most Likely Diagnosis
  • Acute Dacryocystitis: This condition, an infection of the lacrimal sac, is suggested by the patient's symptoms of eye watering, redness, tenderness, and pain, especially with the specific location of redness along the cheek and nose line, which corresponds to the area over the lacrimal sac. The worsening of symptoms over time also supports this diagnosis.
• Other Likely Diagnoses
  • Conjunctivitis: This could be viral or bacterial, given the redness and watering of the eye. However, the specific tenderness and location of pain might lean more towards a condition affecting the lacrimal apparatus.
  • Blepharitis: Inflammation of the eyelids could cause redness, watering, and tenderness, but the specific pattern of pain and the involvement of the area along the nose line might not be as typical.
  • Sinusitis: Given the location of pain and redness along the cheek and nose line, sinusitis could be considered, especially if there are other symptoms like nasal congestion or headache.
• Do Not Miss Diagnoses
  • Orbital Cellulitis: Although less likely given the description, this condition is a serious infection of the tissues surrounding the eye and could present with similar symptoms. It requires prompt antibiotic treatment to prevent serious complications.
  • Endophthalmitis: A severe infection within the eye, usually following surgery or trauma, which could present with severe eye pain, redness, and vision changes. The history does not strongly suggest this, but it's a critical diagnosis not to miss due to its potential for vision loss.
• Rare Diagnoses
  • Lacrimal Gland Tumor: While rare, a tumor in the lacrimal gland could cause localized pain, redness, and possibly affect tear drainage, leading to watering of the eye.
  • Sarcoidosis: This autoimmune condition can affect various parts of the body, including the eyes, and could potentially cause the symptoms described, although it would be an uncommon presentation.