June Week 1: Preseptal & Orbital Cellulitis


Hauser A, et al. Periorbital and orbital cellulitis. Peds in Review. 2010;31:242-249.

You are seeing a 6 year old male in clinic who presents with a 1 day history of progressive swelling of the right eyelids. On exam he is nontoxic but febrile and there is marked swelling, warmth, erythema and tenderness of the eyelids on the right. He is able to open his eye partially and you assess that there are no changes to his vision, no proptosis and his extraocular movements are all intact. 
What else do you want to know about his history? 
What is on your differential diagnosis and how would you confirm your diagnosis? 
How would you treat this boy? What organisms should you cover for?

The next day a 3 year old female presents to your clinic with a similar story of a 1 day history of progressive eyelid swelling of the right eye with warmth, erythema and tenderness. You are unable to open her eye in the office to assess her vision. 
What should your next step be? 
What findings on your eye exam make you worried about orbital cellulitis? 
You obtain a CT scan and find that she has orbital cellulitis. What is your next step? 
Without prompt treatment, what complications would you be worried about