Orbital cellulitis in a burned child

Abstract

A 6-month-old was admitted to our burn center for a 15% TBSA scald burn to his lower extremities, groin, buttocks and abdomen. His past medical history was significant for hydrocephalus. The patient became febrile on hospital day 6. Blood cultures showed infection with methicillin resistant Staphylococcus aureus (MRSA). The patient completed a course of intravenous vancomycin and tobramycin. On hospital day 42 the patient became febrile and developed swelling of the right lower leg. Lower extremity Doppler ultrasound revealed a thrombosis of his common iliac vein. Blood cultures revealed MRSA. Three days later he was noted to have right upper eyelid edema (Plate 1). At this time the ophthalmology service was consulted. On examination, the child was intubated and mildly sedated. Visual acuity was difficult to assess secondary to his level of sedation. The pupils were brisk with no evidence of an afferent papillary defect. The child was moving his eyes and grossly there appeared to be no ocular motility deficit. The right upper lid was swollen with loss of the normal lid crease. The eyelid was mildly erythematous with no palpable fluctuance. Manual palpation of the right orbit revealed increased resistance as compared to the left orbit. The portable slit lamp exam