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

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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

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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

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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

All the options are to be investigated

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Preseptal cellulitis CT

CT

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May be orbital cellulitis.adv. systemic

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C.blood culture

To rule out orbital infection SECONDARY to chronic ethmoidal sinusitis. Cavernous sinus thrombosis to be ruled out.
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CT SCAN

Antibiotics and CT scans orbital and PNS

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