Although uncommon, this is a sight-threatening condition and hospitalization is required. Apart from eyelid swelling, proptosis and restricted ocular motility with pain on attempted eye movement, the patient may also complain of reduced vision. Systemic symptoms may include malaise and fever. The warning signs of orbital cellulitis are a dilated pupil, marked ophthalmoplegia, loss of vision, afferent pupillary defect, papilledema, perivasculitis and violaceous lids. Systemic sepsis work-up, including CT scan of sinuses, orbits and brain, blood culture or even lumbar puncture, is needed if meningeal or cerebral signs develop. Urgent ear, nose and throat (ENT) consultation should be arranged and systemic intravenous broad-spectrum antibiotics, covering Gram-positive, Gram-negative and anaerobic organisms are indicated. Surgical drainage may be needed in selected cases.
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