One must consider orbital cellulitis in this patient.
Periorbital (preseptal) cellulitis often presents with edema, erythema,
and pain. One may also see chemosis, conjunctivitis, fever, and
leukocytosis. Children with mild cases may be successfully treated
as outpatients with oral antibiotics, as long as close primary care
or ophthalmologic follow-up is assured. In the presence of proptosis,
impaired or painful eye movements, or impaired vision, one must
suspect orbital cellulitis. Treatment includes hospitalization for
further work-up, possible consultation, and treatment with IV antibiotics.
Surgical intervention may also be required; however, immediately transferring
this patient to an OR is premature as she does not demonstrate absolute
indications for surgery at this time. Indications for surgery include
diminishing visual acuity, lack of improvement despite proper treatment,
or suggestion of development of orbital abscess or cavernous venous
thrombosis. Warm compresses and oral antihistamines may be appropriate
for mild cases of periorbital irritation due to an allergy or bug
bite, but are not appropriate in this case.