What’s Your Diagnosis? An Evidence-Based Approach to Nontraumatic Ocular Complaints in Children
January 20, 2021
Posted by Andy Jagoda MD in: What's Your Diagnosis , trackback
Welcome to this month’s What’s Your Diagnosis Challenge!
But before we begin, check to see if you got last month’s case on Pediatric Influenza in the Emergency Department: Diagnosis and Management right.
Case Presentation: An Evidence-Based Approach to Nontraumatic Ocular Complaints in Children
A 6-year-old boy with autism is brought to the ED for swelling of his right eye…
- His mother tells you that he has had thick nasal discharge for the past week and has developed pro- gressive redness and fullness of his right eye. He is cranky and holding his head in pain.
- The boy’s vital signs are: temperature, 39°C (102.2°F); heart rate, 135 beats/min; respiratory rate, 25 breaths/min; blood pressure, 100/80 mm Hg; and oxygen saturation, 98% on room air. Your examina- tion reveals a tired child with swelling and redness around the right eye. The patient refuses to open his eyes, and you are unable to perform an ocular examination. The boy’s nasal turbinates are swollen.
- You consider both periorbital and orbital cellulitis in your differential diagnosis and wonder whether the boy needs emergent imaging.
By engaging the family and using video for distraction, you obtained an ocular examination that was notable for right-sided proptosis and ophthalmoplegia. Given the proptosis and associated headache, you obtained a CT scan, which revealed orbital cellulitis complicated by subperiosteal abscess. Ophthalmology and otolaryngology were consulted and broad-spectrum antibiotics were initiated.