Ace the APEA Management EENT Exam 2026 – Elevate, Energize, Excel!

The main idea here is an infection of the lacrimal drainage system, specifically the lacrimal sac, which presents with medial canthal swelling and signs of acute inflammation. When the lacrimal sac is inflamed and obstructed, tears and bacteria can accumulate, causing painful, warm, red swelling just inside the eye toward the nose. The tearing and the purulent material that appears at the puncta when you press on the lacrimal sac—often described as regurgitation—are classic signs that the infection involves the lacrimal sac itself. This distinguishes it from eyelid problems. Blepharitis affects the eyelid margins with crusting and irritation but not a tender medial canthal mass with sac regurgitation. Hordeolum is an acute eyelid-margin infection causing a painful lump at the lid edge, while chalazion is a typically less painful, chronic lump from a blocked meibomian gland. The combination of medial canthal swelling, tenderness, tearing, and purulent punctal discharge on sac pressure most strongly points to acute dacryocystitis.