A 6-year-old boy presents with a 2-day history of right upper eyelid swelling, erythema, and fever. On examination, there is tense swelling of the preseptal tissues, visual acuity is 6/6, pupils are equal and reactive, and ocular motility is full and painless. The most appropriate next step in management is:

• A Intravenous antibiotics and urgent orbital CT scan
• B Lateral canthotomy and inferior cantholysis
• C Oral amoxicillin-clavulanate and outpatient follow-up ✓
• D Endoscopic sinus drainage

Explanation

The clinical picture is consistent with preseptal (periorbital) cellulitis, which is distinguished from orbital cellulitis by normal vision, absence of relative afferent pupillary defect, and painless full ocular motility. Preseptal cellulitis in a child without orbital signs is managed with oral antibiotics (amoxicillin-clavulanate) and close outpatient follow-up. Intravenous antibiotics and CT are reserved for suspected orbital cellulitis or lack of improvement.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

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Written and medically reviewed by the StethoPrep medical team.