Periorbital and orbital cellulitis

Case history

A 9-year-old boy is brought to the emergency room with redness and swelling around his eye that has been present for 1 day. His left eyelid is red, tender to touch, and swollen. It will not open fully and he has a slightly decreased confrontational visual field in the left eye superiorly. He is afebrile and vital signs are normal. He denies any decrease in vision or double vision and his examination is significant for best corrected vision of 20/25 (right eye) and 20/25 (left eye). He has full motility of both eyes, has no relative afferent pupillary defect, and has eye pressures of 16 mmHg (right eye) and 18 mmHg (left eye). His conjunctiva and sclera are within healthy limits and the anterior chamber is deep and quiet. Fundus findings are normal in the left eye and the rest of his examination is within healthy limits. No masses are palpable. CT of orbits and sinus reveals absence of orbital fat stranding and subperiosteal abscess. The patient has an opacified ethmoid and frontoethmoidal recess on the left side.[Figure caption and citation for the preceding image starts]: Swollen and red left eyelidFrom the personal collections of H. Jane Kim, MD, and Robert Kersten, MD, UCSF; used with permission [Citation ends].[Figure caption and citation for the preceding image starts]: Coronal CT post contrast: opacified ethmoid and frontoethmoidal recess on the left sideFrom the personal collections of H. Jane Kim, MD, and Robert Kersten, MD, UCSF; used with permission [Citation ends].[Figure caption and citation for the preceding image starts]: Axial CT post contrast: opacified ethmoid and frontoethmoidal recess on the left sideFrom the personal collections of H. Jane Kim, MD, and Robert Kersten, MD, UCSF; used with permission [Citation ends].