SAQ 416 – Paediatrics – orbital cellulitis with eye swelling

Review Completed

Marked out of 12.00

A 6-year-old girl is brought to the emergency department by her parents. She is febrile, unwell, and complains of a painful right eye. The left periorbital region is normal. Her photograph is shown below.

Clinical photograph showing marked right periorbital swelling and erythema in a febrile child. — Clinical photograph

List four (4) examination findings that would suggest a major complication, and name the complication.

(Marked out of 4.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Examination finding</th> <th>Complication suggested</th> </tr> </thead> <tbody> <tr> <td>1.</td> <td></td> </tr> <tr> <td>2.</td> <td></td> </tr> <tr> <td>3.</td> <td></td> </tr> <tr> <td>4.</td> <td></td> </tr> </tbody> </table> <p>

/ 4

List three (3) investigations and justify each.

(Marked out of 3.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Investigation</th> <th>Justification</th> </tr> </thead> <tbody> <tr> <td>1.</td> <td></td> </tr> <tr> <td>2.</td> <td></td> </tr> <tr> <td>3.</td> <td></td> </tr> </tbody> </table> <p>

/ 3

List five (5) management priorities, including brief detail.

(Marked out of 5.0)

/ 5

Total Score: 0 / 12

Percentage: 0%

Finding	Complication suggested
Reduced visual acuity, colour vision, or relative afferent pupillary defect	Optic nerve compromise or orbital compartment process.
Painful or restricted extra-ocular movements	Orbital cellulitis or orbital abscess.
Proptosis or tense eyelids	Orbital abscess, orbital cellulitis, or raised orbital pressure.
Ophthalmoplegia, diplopia, or cranial nerve abnormality	Orbital apex/cavernous sinus involvement.
Altered mental state, meningism, or severe headache	Intracranial extension such as meningitis, abscess, or cavernous sinus thrombosis.

Investigation	Justification
CT orbits and sinuses with contrast	Identifies orbital cellulitis, subperiosteal/orbital abscess, sinus disease, and need for surgery.
FBC, CRP, EUC, and blood glucose	Assesses inflammatory severity, renal function, metabolic derangement, and safety of antibiotics/contrast.
Blood cultures before antibiotics if this does not delay treatment	May identify bacteraemia and guide therapy.
Swab of any discharge	May support later antimicrobial tailoring.

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