Author: Naomi Brown, Mikhail Vella-Baldacchino / Editor: Sarah Edwards / Codes: GP9, NeuP2, OptC2, OptC3, SLO5 / Published: 24/03/2025
An 11-year-old female initially presented to the Paediatric Emergency Department (ED) with 11 day history of left sided ptosis, supra-orbital swelling and mild left periorbital oedema. Previously fit and well. There was history of trauma or head injury, no infective or coryzal symptoms and no recent foreign travel. Patient is normally fit and well and not on any regular medications.
Examination noted a peri-orbital erythematous swelling with dependent oedema in temporal region and lower lid. No changes to visual acuity, no pain on eye movements, no restriction in eye movements, no proptosis no RAPD. The patient was referred to ophthalmology who reviewed and treated the patient for pre-septal cellulitis with a course of oral co-amoxiclav.
The patient re-presented to the ED, 4 days later with progression in her supraorbital swelling and peri-orbital oedema. The patient was well on first presentation to Emergency department but in last few days has vomited eight times and has a mild headache.
