Orbital Cellulitis


Step 1: View clinicals

A 12-year-old girl presents with redness, swelling, and protrusion of her left eye since waking up a couple of hours ago. There is no alteration in the vision of the affected eye. Her history is significant for left-sided central facial pain for one day, and a frontal headache and rhinorrhea for two days. Her mother put these symptoms down to a case of 'sinus infection' and did not seek medical attention. There is no history of facial trauma or insect bites to the affected area. Her medical, surgical, drug, allergic, and family histories are all unremarkable.

Step 2: Order all relevant investigations

Complete blood count

WBC: 13,500/mm3 (4,100-8,900) N: 9,500/mm3 (1,800-8,000) L: 2,100/mm3 (1,200-5,700) Hb: 13.2 g/dL (12.0-14.0) Plt: 300,000/mm3 (150,000-400,000)

Contrast CT Orbits + Brain

The CT scan reveals a small left-medial subperiosteal abscess and left ethmoid sinusitis. No other abnormalities are noted.

Blood cultures

Culture results will be available in 48 to 72 hours.

Lumbar puncture

The CSF analysis shows no abnormalities. Culture results will be available in 48 to 72 hours.

Step 3: Select appropriate management

ICU admission
IV antibiotics
Nasal decongestants
Surgical drainage

Score: ★★☆