Periorbital Swelling

First actions / assessment

• Assess ABCDE if systemically unwell. Clarify onset, unilateral versus bilateral swelling, pain, tenderness, erythema, itch, fever, URTI or sinus symptoms, insect bite, trauma, vision change, diplopia, pain on eye movement, headache, vomiting, discharge, allergy history, nephrotic or renal symptoms, reduced urine output, recent skin lesions, and immunosuppression. Examine visual acuity in each eye, pupils, ocular motility, proptosis, conjunctiva, chemosis, eyelid erythema/warmth/tenderness, cranial nerves where relevant, temperature, hydration, blood pressure, and for generalized oedema. Unilateral painful erythematous swelling suggests preseptal/orbital infection
• bilateral soft non-erythematous swelling suggests allergic or renal causes. Contrast CT of the orbits/sinuses is preferred when orbital cellulitis is suspected
• do not delay escalation for imaging in a deteriorating child. Urinalysis, serum albumin, creatinine, and blood pressure are helpful if nephrotic/nephritic syndrome is possible.