Severe mucopurulent discharge is suggestive of:

• keratoconjunctivitis sicca
• bacterial keratoconjunctivitis
• dacryocystitis

The cornea is remarkably clear, making KCS unlikely. Flushing of the nasolacrimal duct confirms a diagnosis of dacryocystitis. Treatment in these cases can be challenging and usually involves a combination of systemic and topical antibiotics as well as repeated flushing of the nasolacrimal duct with antibiotics (every 1-2 days for 10-20 treatments). Lack of response to therapy is an indication for radiographs (including contrast studies) to rule out neoplasia or fistulas.

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