Dr. Paul Karpecki
This child presented with a conjunctivitis that was treated, but the preseptal cellulitis was not recognized at the time. The patient returned in significant pain and distress. Note the significant reddish sheen around the eyes and bridge of the nose. The patient was diagnosed with preseptal cellulitis although a cellulitis could not be ruled out given the pain that appeared to be present with eye movement. The patient was referred to a pediatrician and admitted to the hospital.
The key pearls to this case are the need to go beyond conjunctivitis in children. Pathogens such as h.flu and s. pneumo can often cause more serious sequelae such as preseptal cellulitis. Look for a reddish sheen around the eyes, ask about co-morbidities such as otitis media, significant malaise, an URI, fever, etc. All of these indicate a systemic component which warrants more than topical therapy.