A 3-year-old develops a strawberry-red tender swelling around the right eye over 24 hours with proptosis, painful limitation of eye movement, and fever. CT orbit shows subperiosteal collection. This is periorbital vs. orbital cellulitis. The correct management is:

• A Topical chloramphenicol and oral amoxicillin-clavulanate
• B IV ceftriaxone + metronidazole and urgent ENT/ophthalmology review ✓
• C IV vancomycin alone for MRSA coverage
• D Oral clindamycin and twice daily warm compresses

Explanation

Proptosis and painful restriction of eye movement indicate orbital cellulitis (postseptal), not preseptal cellulitis. CT showing subperiosteal collection confirms orbital involvement. This is a sight-threatening (and potentially life-threatening — cavernous sinus thrombosis risk) emergency requiring: hospitalization, IV antibiotics (ceftriaxone covering Streptococcus, Haemophilus; metronidazole for anaerobic organisms from sinusitis), and urgent ENT/ophthalmology review for surgical drainage assessment. Preseptal cellulitis (no proptosis, no restricted movement) can be managed with oral antibiotics. Topical antibiotics have no role in orbital cellulitis. IV vancomycin alone misses Gram-negative coverage from sinus flora.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.