SAQ 129 – Paediatrics – orbital cellulitis

Review Completed

Marked out of 12.00

A 4 year old girl presents with a painful right eye for the last 1 day.

A photograph of the girl is shown below.

Using the table provided, list six (6) clinical features that would differentiate between insect bite, preseptal and orbital cellulitis.

(Marked out of 6.0)

/ 6

Assuming the diagnosis is orbital cellulitis, list three (3) key management points for this patient. Provide one justification for each choice.

(Marked out of 6.0)

/ 6

Total Score: 0 / 12

Percentage: 0%

Clinical feature	Insect bite	Preseptal cellulitis	Orbital cellulitis
Source	Bite witnessed or visible	No	No
Systemic features such as unwell, febrile, nauseated	No	Possible	Very likely
Ophthalmoplegia / reduced eye movements	Absent	Absent	Present
Proptosis	Absent	Absent	Possible late sign
Anterior changes such as chemosis	Absent	Absent	Possible
Reduced visual acuity	No	No	Possible
Relative afferent pupillary defect	Absent	Absent	Possible

Key management point	Justification
IV antibiotics, for example IV flucloxacillin plus ceftriaxone	Infection with serious complications requiring parenteral antibiotics; cover Staphylococcus, Streptococcus, and Haemophilus influenzae.
Analgesia	Very painful condition.
Admit and obtain urgent ophthalmology consultation	May require orbital decompression if CT proves an abscess.