A 10 year-old boy has 3 days of severe pain and swelling of his left eye. 2 weeks ago, he had nasal congestion and a constant headache. He denies any recent insect bites or trauma. He appears ill and reports occasional chills. Vision is intact in the right eye, but decreased in the left eye. The left eyelids are erythematous and tender to touch. Ocular motility is normal but causes severe pain.
Which of the following is the most likely etiology of his symptoms?
A. Cavernous sinus thrombosis
B. Spread of dacrocystitis
C. Bacterial infection from ethmoid sinus
D. Allergic periorbital edema
The correct answer is C.
This patient most likely has (C) bacterial infection from ethmoid sinus. He has impaired vision, proptosis, eyelid erythema, tenderness, and severe pain with ocular movement which is indicative of orbital cellulitis. Orbital cellulitis is commonly caused by bacterial spread from the ethmoid or maxillary sinus especially if the patient had a recent history of sinusitis. Cavernous sinus thrombosis (A) would instead present with symptoms related to damaged cranial nerves responsible for ocular motility, such as ophthalmoplegia. A dental abscess (B) would typically present with pain in the area of the abscess, as well as systemic symptoms. A spread of dacryocystitis (C) can rarely cause orbital cellulitis, but this patient does not show symptoms of dacryocystitis (tenderness of the medial canthal area, discharge from the punctum). Allergic periorbital edema (D) causes painless, non-tender eyelid swelling often associated with itching and other allergic symptoms. It does not cause fever, decreased vision, or painful eye movements and is not infectious.