An Infant With Redness and Swelling Near the Eye

Ann L. Chou; Kimberly G. Yen, MD


March 19, 2013

Clinical Presentation

A 6-month-old full-term boy presented to the emergency department with tenderness and swelling below the middle corner of his right eye for 7 days. The parents noted that the mass near his eye had been growing larger for the past 2 weeks and that the area was quite red and swollen. The child also had green discharge from the right eye.

The mother said that the child had not had fever. She stated that he had been a little fussy but was eating and sleeping well. He was otherwise healthy and had no history of surgeries. However, he had had chronic tearing and mucoid discharge from the right eye since birth. The child had been intermittently treated with topical antibiotics in the right eye, but the problem never resolved completely.

On ocular examination, the patient demonstrated fix-and-follow behavior with each eye without fixation preference. A tender, erythematous, 1-cm area of swelling in the region of the right lacrimal sac was noted (Figure). Green discharge was expressed from the right eye when gently compressed. No proptosis was observed. The patient's motility was full, and eye movement did not seem to cause discomfort. The remainder of the anterior segment and posterior segment examination was normal.

Figure. Photograph of the patient, showing a 1-cm area of swelling and erythema near the right lacrimal sac with green discharge coming from the eye.