Abstract
A 59-year-old diabetic woman presented with acute dacryocystitis in her left eye and visual acuity of finger counting at two feet and was initially treated with topical and systemic antibiotics. However, her condition deteriorated, leading to left orbital cellulitis and a significant reduction in vision, with no perception of light. Prompt drainage of the lacrimal abscess was performed, and she was administered parenteral antibiotics. The patient showed clinical improvement and subsequently underwent external dacryocystorhinostomy after the acute infection had subsided. Unfortunately, her visual acuity did not improve significantly, with only a positive perception of light. Magnetic resonance imaging during the acute phase revealed optic nerve enhancement and focal signal changes, which persisted even after the infection had resolved. Acute dacryocystitis rarely advances to orbital cellulitis, which can result in vision loss, with only a few documented cases in literature. It is crucial to closely monitor such patients and promptly intervene with imaging and parenteral antibiotics, along with abscess drainage if indicated.