DGR #165

Hint #1 | Hint #2
Hint #3 | Hint #4 | Answer

History:
History of Present Illness: A 35 year old Latino presents from the ED c/o red and painful lump just below the nasal aspect of the LLL. Over the past year, he has had 21 visits associated with "dacryocystitis". He has had a succession of topical antibiotic ointments and solutions accompanied by various oral antibiotics. In each case, his condition never completely resolved. 3 nasolacrimal probes have been done over the past year with resolution only being about a month by ophthalmology. The patient is in generally good health with no significant or relevant medical problems. Except for this eye problem, he is taking no other medications. He is a construction worker. Physical Examination: 1. 20/20 Best vision in each eye. PERRLA. Full EOM. No strabismus by corneal reflex test. 2. Hard red bump in the area under the nasal aspect of the LLL. 3. Body Temp 99.1. Weight 215 Ht 5'10" BP 125/79 4. Quiet AC, White Conjunctiva 5. Fundus normal in all respects 6. IOP 14mm in each eye. 7. MRI and CT are negative for tumors or calcified growths 8. Cultures are inconclusive What would you do?



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