Something in your eye: Periorbital cellulitis

Case presentation

A 7-month-old baby presents with left infraorbital swelling and erythema for the past 2 days, which has progressed rapidly. There has been a fever of 101.5 degrees Fahrenheit for the past 24 hours. He has not had cough, congestion, vomiting, or diarrhea. Four days ago, the child was playing with his older sibling, who, during the course of play, threw a small toy car at the child, striking him in the left side of the face (under the eye) and causing a small abrasion. The wound did not appear large and the mother has been keeping the area clean with soap and water. He has been eating and drinking well and is otherwise at his baseline.

Physical examination reveals a child in no distress. His temperature is 100.1 degrees Fahrenheit, his heart rate is 137 beats per minute, and his respiratory rate is 30 breaths per minute. He has obvious erythema and swelling to the left periorbital area, particularly the infraorbital area, which is warm and is painful when palpated. There is no fluctuance, but there is induration. The child is unable to open the eye (which you find very difficult to open due to the swelling) and consequently the pupil, conjunctiva, and sclera are not visible. There is no proptosis. There is moderate yellow eye discharge and eyelash mattering.

Imaging considerations