In acute dacryocystitis, localized skin redness, pain, and pressure are evident, and the inflammation may spread to the cheek, nasal bridge, and eyelids. When it spreads to the eyelids, it can sometimes be mistaken for a wheals. Acute dacryocystitis is an acute purulent inflammation of the lacrimal sac and its surrounding tissues. Because the nasolacrimal duct is blocked, the tears inside the tear sac cannot drain, and the retained tears become a place for bacteria to grow and multiply, creating chronic dacryocystitis. Some chronic inflammation of the lacrimal sac can spread to the surrounding area and become acute lacrimal sac inflammation. Therefore, acute dacryocystitis is mostly triggered by chronic dacryocystitis, and only a few start out as acute inflammation, which means that acute dacryocystitis usually has a history of chronic dacryocystitis. Sometimes acute dacryocystitis can also develop due to trauma to the lacrimal sac, or a false tract caused during a lacrimal duct exploration, or a bacterial infection after lacrimal sac surgery. A whealsore is a boil on the eyelid that grows on the eyelid and is often called a “needle eye” or “needle stealer’s eye”. A whealsore is caused by an infection of the eyelid gland or follicle and its accessory glands. It is red and painful at first and can become pus-filled after three to five days. When the pus is drained, the redness and swelling subside, the swelling and pain are relieved, and it can heal completely in a few days. It can be seen that the site of acute dacryocystitis is different from that of mydriasis, the site of pressure and pain is different, and the symptoms are not exactly the same. Acute dacryocystitis also forms an abscess cavity after a few days, and the inflammation quickly subsides after the pus is broken and drained, but often leaves a fistula in front of the dacryocyst, and most of them do not heal for a long time, which is also different from mydriasis. The early symptoms of acute lacrimal dacryocystitis may be similar to those of wheals, but they have different causes, different medical histories, different sites of onset, different prognoses, and different clinical manifestations. Therefore, with careful observation and analysis it is not difficult to differentiate.