An 8-year-old child presents with acute onset of painful periorbital swelling, proptosis, restricted extraocular movements, and fever. CT orbit shows a subperiosteal collection medial to the right orbit with displacement of the globe laterally and opacification of the ethmoid sinuses. The most likely source of infection and the most critical complication to monitor for is:

• A Dental abscess; orbital cellulitis
• B Dacryocystitis; lacrimal fistula
• C Preseptal trauma; orbital abscess
• D Ethmoid sinusitis; cavernous sinus thrombosis and optic nerve compression ✓

Explanation

Orbital cellulitis in children most commonly arises from ethmoid sinusitis, as the thin lamina papyracea separates the medial orbit from the ethmoid sinuses. The Chandler classification grades orbital complications from preseptal cellulitis (grade I) through subperiosteal abscess (grade III) to orbital abscess (grade IV) and cavernous sinus thrombosis (grade V). The most critical complications are optic nerve compression causing vision loss and cavernous sinus thrombosis. IV antibiotics are first-line; surgical drainage is indicated for large abscesses or vision threat.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.