Isi Esquenazi; Kimberly G. Yen, MD; Douglas P. Marx, MD


February 28, 2013

Clinical Presentation

A previously healthy 4-year-old boy was seen by the ophthalmology service after his mother noticed swelling of his right orbit for 2 weeks with associated discomfort. The mother reported that the child was previously seen in an outside emergency department and was prescribed antibiotics with no signs of improvement. The child was otherwise healthy and developing normally. He had no family history of ocular diseases.

On ocular examination, the child was able to fix and follow with both eyes. He was orthotropic and extraocular movements were within normal limits bilaterally. External examination revealed extensive periorbital edema on the right side, with the most significant edema involving the upper eyelid (Figure 1). Anterior segment examination revealed a small amount of mucoid discharge. The remainder of the slit-lamp examination was within normal limits, including no hyperemia or chemosis. Posterior segment examination was within normal limits on both sides.

CT of the orbits with contrast revealed a soft tissue mass located in the superolateral right orbit with associated erosion of the adjacent orbital rim, roof, and lateral orbital wall. Additionally, there was inferior and medial displacement of the right globe due to the soft tissue mass.

Figure 1. Clinical image demonstrating extensive superior right periorbital edema with erythema and mucoid discharge.