Two days after diagnosing sinusitis, the child returns with swelling of the eye, redness, inflammation, and impaired extraocular movement in the right eye. Which action is most appropriate?

Two days after diagnosing sinusitis, the child returns with swelling of the eye, redness, inflammation, and impaired extraocular movement in the right eye. Which action is most appropriate?

• A. Reassure mom that this is common & benign
• B. Order anti-inflammatory eye drops
• C. Refer Tom immediately
• D. Treat for bacterial conjunctivitis

Answer: (C)

Recognizing orbital involvement is essential when sinusitis is followed by eye swelling, redness, and impaired extraocular movements. These signs suggest orbital cellulitis, a serious infection that can threaten vision and spread to the brain if not treated promptly. The most appropriate action is to refer immediately for urgent inpatient evaluation and IV broad‑spectrum antibiotics, with imaging (CT or MRI) to define extent and look for an abscess. Reassurance, anti‑inflammatory eye drops, or treating as simple conjunctivitis would miss the urgency and allow progression, since conjunctivitis generally does not cause restricted eye movements or the same level of orbital danger. Early specialist assessment and IV therapy are the keys to preventing complications.

Recognizing orbital involvement is essential when sinusitis is followed by eye swelling, redness, and impaired extraocular movements. These signs suggest orbital cellulitis, a serious infection that can threaten vision and spread to the brain if not treated promptly. The most appropriate action is to refer immediately for urgent inpatient evaluation and IV broad‑spectrum antibiotics, with imaging (CT or MRI) to define extent and look for an abscess. Reassurance, anti‑inflammatory eye drops, or treating as simple conjunctivitis would miss the urgency and allow progression, since conjunctivitis generally does not cause restricted eye movements or the same level of orbital danger. Early specialist assessment and IV therapy are the keys to preventing complications.