Question of the Week
Video Library
Ophthalmology Books & Manuals
Cybersight Atlas of Eye Diseases
The Ophthalmology Minute
Nursing Education
Eye Care Equipment
Orbis Program Features
Free Online Journals
Ophthalmology Links
Frequently Asked Questions (FAQ)
Print ViewPrint this Page
Answers: 2010 Series -  August 31, 2010 Lecture 18 of 52  NEXT»

To see views enlarged, click on the individual pictures...

QOW.Aug31.Image1             QOW.Aug31.Image2

This 2½-year-old boy developed an infection diagnosed as chickenpox (varicella virus). Three days ago he developed increased redness and a pustule on the left upper lid. The lid is now swollen closing the eye. Three days ago he was placed on antibiotics and antiviral medication under the direction of his pediatrician. Looking carefully behind the left upper lid the eye appears normal.

1. This patient is now demonstrating:

a -- preseptal cellulitis

This is obviously preseptal cellulitis.

2. Having this infection now makes this child potentially susceptible for what disease in the future?

c -- herpes zoester

People who develop herpes zoster must have had prior “chickenpox”.

3. How should the lid be dealt with now?

b -- warm compresses waiting for spontaneous drainage

Warm compresses and waiting for spontaneous drainage is a valid course.

The Cyber-Sight mentor provided the following:

"If you are sure the cellulitis is preseptal, there is no proptosis and the eye looks reasonably good behind the lid and as you say, the child seems to be a little better, I would not think it necessary to drain the upper lid. Unless you feel and see a discrete pustule, the incision, and that tissue I see on the lid may be one, you will most likely just cut into tissue that seeps but does not yield the "gush" of puss you might hope to see come out.

On the other hand, a small incision parallel to the lid margin a few mm above the lash line over the top of a pustule would probably not be of any harm regarding a scar, but in the condition you describe, I do not think a lid incision would help this child.

Of course, post septal cellulitis is another and more serious story.
Have you done imaging? It is probably not necessary.
You could try warm soaks. It looks like you are doing the right thing.
Let me know how this turns out."

The partner responded the next day saying that the upper lid swelling drained spontaneously and that the patient continues to improve.

Lecture 18 of 52 «Previous Lecture   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52    Next»