A 12-year-old with acute ethmoiditis has proptosis, reduced colour vision, ophthalmoplegia and a medial subperiosteal orbital collection on CT. Visual acuity is deteriorating despite IV antibiotics. What is the next step?
Orbital signs plus worsening visual function are an operative emergency; drainage must include the sinonasal source and be coordinated with ophthalmology.
A. Continue antibiotics for another 48 hours before reassessment: Visual deterioration indicates threatened optic function and removes the option of prolonged observation.
B. Needle aspirate through the eyelid without sinus surgery: This may miss the collection and fails to drain the infected ethmoid source.
C. Give intranasal steroid alone: Steroid cannot control an abscess with threatened vision.
D. Urgent endoscopic sinus drainage with orbital decompression in conjunction with ophthalmology: Progressive visual compromise requires immediate source control, drainage and serial postoperative visual assessment.
E. Perform lumbar puncture: This neither treats the orbital infection nor protects vision.
If vision, colour perception and pupils were normal and a very small medial collection improved rapidly on IV antibiotics, closely monitored conservative treatment could be considered.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, or a substitute for local policy and specialist clinical judgement.
Back to the Section 1 bank