Paediatric Ophthalmology: Case five

Special thanks to Miss Karen Jones, Chief Photographer, West of England Eye Unit, Exeter for developing the CT scan.

This 8 year old presented to the eye casualty with a five-day history of swollen right eye which was unresponsive to oral augmentin prescribed by her GP.

a. What does the CT scan show?

The CT scan shows a right proptosis with opacification of the right ethemoidal sinus. The diagnosis is orbital cellulitis due to ethmoidal sinusitis.

b. What complications can develop?

    Complications of orbital cellulitis include:
    • subperiosteal and orbital abscess. This should be suspected when there is marked systemic toxicity and severe orbital signs, or when the orbital cellulitis is slow to respond to adequate doses of intravenous antibiotics.
    • cavernous sinus thrombosis. There is severe pain and multiple cranial nerve palsies (3rd, 4th and 6th nerves)
c. How would you treat this patient?
    The patient should be admitted for intravenous antibiotics. The antibiotics should be chosen to cover the common causative organisms:
      • H. influenzae
      • Staph. aureus
      • Streptococcus pneumoniae
      • Strep. pyogenes
    H. influenzae is the most common pathogen in this age group. The choice of antibiotics should either be augmentin (to cover penicillin-resistant strains) or cefuroxime.

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