May Week 5

Pediatrics in Review: Periorbital and Orbital Cellulitis, Hauser and Fogarasi, 2012

A mother brings her 3 y/o son to clinic because his right eye looks “swollen.” He woke up this way a few hours ago. He’s had a cold, runny nose, and cough for the past 3-4 days. He has been afebrile and acting appropriately, until this morning. Today, mom thinks he is fussy and “not himself.” On exam, his right upper eyelid is markedly swollen and the child can minimally open his eye. You think the pupils are equal and round, reactive to light. It also appears that the extra-ocular movements are intact. He doesn’t seem to be sensitive to light. The left eye is entirely normal. There is no tenderness to palpation of the ethmoid, maxillary or frontal sinuses. There is clear drainage from the nose. The rest of the exam is unremarkable. Vitals are all normal and the child is afebrile.

1) What is the likely diagnosis?
2) What are the routes of infection? 
3) What are the likely organisms?
4) What would you consider for treatment and when would you admit this patient to the hospital (versus outpatient therapy)?

Also, what distinguishes this diagnosis from other diagnoses discussed in the article that are more benign (chalazion, stye, dacroadenitis)?