Physical Address
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Dorchester Center, MA 02124
Can you see it? Orbital cellulitis
Case presentation
A 10-year-old male presents with left eye edema and pain for the past 2–3 days. The child reports mild congestion for the past week but there has been no fever, vomiting, cough, vision changes, eye discharge, or trauma. He states that it is difficult for him to completely open the eye because of the swelling. When he does, he complains of generalized eye pain. He has not had fever, although during your evaluation, you note that the child has a temperature of 100.9 degrees Fahrenheit, with a heart rate of 105 beats per minute, a respiratory rate of 18 breaths per minute, and a blood pressure of 100/75 mm Hg. The physical examination is unremarkable except for obvious left upper and lower eyelid edema with erythema and warmth. There is mild induration and no palpable fluctuance. The patient is able to open his eye, and you note there is no scleral edema or erythema; there is no obvious proptosis; there is no hyphema; his pupil is briskly reactive and equal with his other pupil. He has mild photophobia. When testing his extraocular muscles, the child complains of pain looking primarily medially and laterally. He has a nonfocal neurologic examination.
Imaging considerations
Imaging is often utilized to assist in distinguishing periorbital from orbital or intracranial complications and identifying patients who would benefit from surgical intervention. There have been studies that employed clinical findings, particularly proptosis and limited or painful ocular motion, to risk stratify patients who require imaging. , Not all patients have classic findings for orbital or intracranial involvement , and the decision to obtain imaging depends upon the patient’s presenting history, examination findings, and provider experience and index of suspicion.
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