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Unilateral periorbital swelling in children: avoid delays in diagnosis
1Ophthalmology, All India Institute of Medical Science, Bhopal, Madhya Pradesh, India sarojini94@yahoo.co.in.
Insights
Orbital cellulitis, a serious eye infection, requires prompt diagnosis and treatment to prevent vision loss. Differentiating it from less severe preseptal cellulitis is crucial for effective management in children.
Area of Science:
- Ophthalmology
- Pediatrics
- Infectious Diseases
Background:
- Preseptal cellulitis is a common condition in children, often treated with oral antibiotics.
- Prompt differentiation between preseptal and orbital cellulitis is critical for appropriate management.
Observation:
- A 10-year-old presented with worsening periorbital swelling, proptosis, restricted eye movements, and a relative afferent pupillary defect.
- Initial diagnosis of preseptal cellulitis was revised to orbital cellulitis with sinusitis based on clinical signs and CT scan.
Findings:
- Orbital cellulitis, a severe infection, was confirmed via CT scan, indicating orbital and sinus involvement.
- Treatment involved parenteral antibiotics and endoscopic sinus surgery.
Implications:
- Orbital cellulitis is an ocular emergency requiring immediate intervention.
- Delayed diagnosis can lead to severe vision impairment and life-threatening intracranial complications.
Abstract:
A 10-year-old child had painful periorbital swelling in the left eye. It was diagnosed as preseptal cellulitis and treated with oral antibiotics. Three days later, the ocular condition worsened so the child was referred for further management. On examination, the child had a temperature of 102 °F. Ocular examination revealed proptosis, restricted ocular movements and a relative afferent pupillary defect in the left eye. Ocular examination of the right eye was normal. There was a history of recurrent episodes of cold in the past. CT scan orbit and sinuses revealed signs of orbital cellulitis with sinusitis on the left side. The child was treated with parenteral antibiotics and endoscopic sinus surgery. A child presenting with unilateral periorbital swelling needs to be thoroughly evaluated. It is important to differentiate orbital cellulitis from preseptal cellulitis. Orbital cellulitis is an emergency and delay in diagnosis can lead to vision and life-threatening intracranial complications.
