A Five Year Old with Swelling Around the Eye

3/18/2008

I evaluated a five year old with swelling of the area below the left eye. This is known as the periorbital area (or the area around the eye). The child was minimally irritable and had no fever or vomiting. There was no history of trauma or recent laceration in the area.  On exam the skin had a purplish appearance and was significantly swollen. The eye movements were normal and he did not appear to be very sick.

This child has a very early periorbital or preseptal cellulitis. This is a bacterial infection of the soft tissue around the eye. The periorbital area is predisposed to these infections especially following trauma. The bacteria most associated with the purplish discoloration of the skin is Hemophillus influenza. The area around the eye can get quite swollen especially after waking up from a nap or bedtime. Prolonged periods in the lying position allows the infection and the fluid associated with it to accumulate and cause swelling. The eye can even look like it is swollen shut. As the child walks around the swelling generally improves. Most children have fever with this infection. These infections when treated early are almost always exquisitely responsive to oral antibiotics. More severe infections on occasion require parenteral antibiotics (intravenous or intramuscular). On very rare occasion the infection can spread to the underlying vein that drains the brain. Fortunately this is rarely seen in healthy children.

I treated this young boy with an oral antibiotic, Augmentin, as well as a four week course of probiotics to protect and repopulate the intestinal flora. If he develops persistent fever or the swelling is worsening with time, his mom is instructed to return.

Occasionally swelling around one eye is the result of an insect bite which can cause an allergic reaction. This entity is often confused with periorbital cellulitis as both can cause severe swelling around the eye. Most insect bites occur during warm weather seasons. Often a small bite can be noticed on the skin nearby but the extreme swelling frequently makes this difficult to discern. Insect bites with allergic swelling rarely ever require treatment with an antibiotic. Cool compresses and occasionally a mild antihistamine are all that is needed in this case. I have one patient who applies red cabbage to reduce these allergic reactions on the skin. She simply puts the cabbage in a small volume of water and then places it on the swelling for 15-20 minutes several times throughout the day. It appears to work beautifully.

      

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