A 14-Year-Old Boy With Painful Periorbital Edema

Alexis R. Pascoe, BS; Amit R. Bhatt, MD; Kimberly G. Yen, MD; Eric J. Kim, MD; Madhuri Chilakapati, MD

Disclosures

July 10, 2019

Case Presentation

1A 14-year-old boy with no significant medical history presented to the emergency department with painful periorbital edema and erythema in his right eye for 2 days. He denied any vision change, ocular trauma, insect bite, discharge, fever, viral prodrome, or other constitutional symptoms. On exam, visual acuity was 20/20 bilaterally. Motility exam showed a −3 abduction and supraduction limitation in the right eye, whereas the left eye was full. There was pain with movement. His intraocular pressure was 25 mm Hg in the right eye and 13 mm Hg in the left eye. Slit-lamp exam demonstrated 3+ right upper lid erythematous swelling and 3+ chemosis (Figure 1). The fundus exam was unremarkable. Imaging showed no sign of sinus disease or abscess, but revealed a diffusely enlarged right lacrimal gland with blurred gland margins (Figure 2).

Figure 1. External appearance of presentation.

Figure 2. Diffusely enlarged and enhanced right lacrimal gland with preservation of its overall shape. MRI showing no sign of sinus disease or abscess.

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