The Baby With a Swollen Eyelid

Humberto Salazar; Madhuri Chilakapati, MD; Kimberly G. Yen, MD

Disclosures

November 19, 2018

Case Diagnosis

This patient was diagnosed with preseptal cellulitis, an infection of the eyelid and the soft tissues anterior to the orbital septum that is common in children and young adults. It typically presents, as in this patient, with ocular pain, eyelid swelling, and erythema.[1,2]

Orbital cellulitis is an infection of the orbital soft tissues posterior to the orbital septum that occurs primarily in children and young adults. The typical clinical presentation is similar to that of preseptal cellulitis, with the additional signs of proptosis, chemosis, ophthalmoplegia, or decreased visual acuity. It is a serious condition that can rapidly lead to dangerous complications and requires urgent treatment.[1,2]

Allergic contact dermatitis is a T-cell–mediated, delayed-type hypersensitivity reaction to external allergens in previously sensitized individuals. It is more common in adults and typically presents as erythematous, indurated, scaly plaques, with occasional vesicles and bullae. Lesions are commonly localized to the area of exposure to the allergen, most frequently on the hands, face, or eyelids.[3]

Acute dacryocystitis is an infection of the lacrimal sac and surrounding tissues that often occurs in infants as a complication of nasolacrimal duct obstruction or a dacryocystocele. It typically presents as erythema, swelling, warmth, and tenderness of the lacrimal sac below the medial canthal tendon, with or without purulent discharge. It is a medically urgent condition owing to the possibility of serious complications.[4]

An external hordeolum (or stye) is a purulent inflammation of the eyelid margin affecting the eyelash follicle or lid-margin tear gland. It is commonly caused by bacterial infection, usually staphylococcal, but can also be sterile. The typical presentation is an acute onset, red, painful, swollen furuncle that typically resolves on its own or can scar into a hard chalazion.[5]

Clinical Course

The patient was admitted to the hospital for treatment. After 1 day of intravenous vancomycin and ceftriaxone, the eyelid swelling and erythema were markedly improved and the patient was afebrile. She was discharged with a 7-day treatment course of oral clindamycin. The cellulitis resolved, and she had no complications.

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