A 2-year-old boy with 1 week of upper respiratory infection presents with fever of 38.7°C. His left eye area has redness and swelling. The eyelids are edematous, but he can still open them and able to look around without difficulty. Aside from nasal discharge, the rest of the physical exam is normal. What is the next appropriate step?
Admit for parental antibiotics
+Computed tomography (CT) of the orbit
+Prescribe 10-day course of amoxicillin–clavulanate
+Ophthalmology referral
+Recommend warm compresses along with topic antibiotic ointment
Outpatient management with oral antibiotics is indicated with your diagnosis of periorbital cellulitis. Well-appearing children with no evidence of proptosis or pain with eye movement do not require a CT scan of the orbits. Failure of outpatient management with oral antibiotics or development of orbital cellulitis warrants parental antibiotics as well as an ophthalmology consult. Topical antibiotic would be helpful for a conjunctivitis but not in periorbital cellulitis.