A two year old child with a long history of purulent nasal discharge now presents with fever and right sided conjunctival congestion and edema for the past 3 days, see picture below. his fever is 103 degree Fahrenheit and WBC count is 12000 per microlitre. The culture of eye discharge was negative. X ray show pacification of ethmoid sinus. Which of the following should be the next step in evaluating this patient: a) CT scan b) FESS C) blood culture d) repeat culture of eye discharge
Bacterial conjunjtivitis with preseptal celilitis ,ethmoidal sinusitis has potential of impending orbital cellulitis Augmentin suspension 25 to 40 mg/kg body wt 12 hourly azithromycin suspension 5to 12 mg /kg one time daily ibugesic syrup 2 tsf bd presevative free moxflox e/d two hourly azithromycin e/d 8 hourly If injectable required doses take pedrititian advise
It looks like preseptal cellulitis . It must be differentiated from acute orbital cellulitis Two clinical features are . Chemosis - absent or mild in preseptal cellulitis , but marked in orbital cellulitis. . Ophthalmoplegia - absent in preseptal cellulitis , but present in orbital cellulitis I do not consider visual acuity in a two yrs child in which it is impossible to come to a conclusion Two investigations are vital in this case . CT . MRI Treatment has already been nicely suggested by Dr.Sujan Singh
CT SCAN IT IS AN IN IMPENDING CASE OF ORBITAL CELLULITIS CHILD SHOULD BE ADMITTED DO BLOOD CULTURE ENT CONSULTATION TRATMENT HAS TO E VERY URGENT DONT ALLOW THE CHILD TO GO TO COMPLECTIONS OF ORBITAL ABCESS ONE HAS TO START I V ANTIBIOTIC THERPHY THEN GIE ANTIBIOTICS I V ACCORDING TO REPORT OF BLOOD CULTURE MAY BE CHILD MAY ALSO NEED E NT INTERVENSION
Preseptal cellulitis CT
C.blood culture
CT SCAN
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