A child with sinusitis has proptosis, painful restricted eye movements and declining visual acuity. CT shows a medial subperiosteal orbital abscess. What is the best next step?
Visual decline and an abscess are high-risk orbital complications. Airway and sepsis assessment, IV therapy, serial visual observations and prompt drainage are required when vision is threatened or response is inadequate.
A. Discharge with nasal saline: This risks blindness and intracranial spread.
B. Delay treatment until MRI under general anaesthesia: CT already demonstrates a surgical complication.
C. Treat with topical eye drops alone: The infection is postseptal and sinus-derived.
D. Urgent joint ENT and ophthalmology management with intravenous antibiotics and drainage consideration: Visual decline and an abscess are high-risk orbital complications. Airway and sepsis assessment, IV therapy, serial visual observations and prompt drainage are required when vision is threatened or response is inadequate.
E. Patch the affected eye and observe: Occlusion does not treat infection or pressure.
If there were eyelid swelling without proptosis, pain on movement or visual impairment, preseptal cellulitis could be managed less aggressively with close review.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
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