Which procedure is NOT appropriate for evaluating suspected dacryocystitis?

Dilation and irrigation of the lacrimal system is not appropriate for evaluating suspected dacryocystitis primarily because it can exacerbate the infection. Dacryocystitis, an infection of the lacrimal sac, often presents with swelling, redness, and tenderness in the medial canthal area, alongside purulent discharge.

In this context, digital palpation of the medial canthal area helps to assess the presence of tenderness or swelling that suggests an infection and can elicit discharge if obstructive pathology exists. Evaluating extraocular muscle motility can help rule out associated complications or other conditions affecting ocular movement. Gram stain and blood agar cultures of any discharge obtained during examination help identify the infectious agent, which is vital for guiding appropriate treatment.

In contrast, dilation and irrigation—while useful for diagnosing obstructions under normal circumstances—can introduce bacteria deeper into the lacrimal system or exacerbate existing inflammation, making it inappropriate in the setting of an active infection such as dacryocystitis.