Appropriate initial workup of this patient includes all of the following except:
a complete ophthalmic exam
CT scan of the orbits and sinuses
probing and irrigation of the left nasolacrimal system
culture and Gram stain of the medial canthal discharge
Answer: C) Probing and irrigation of the left nasolacrimal system
Explanation: In acute dacryocystitis, probing of the nasolacrimal system is not indicated. Complete ophthalmic evaluation is necessary to determine whether a surrounding orbital cellulitis is present. Culture and Gram stain may help direct antibiotic therapy. In situations of previous trauma, radiographic imaging will help evaluate any anatomic changes.