Periorbital and orbital cellulitis (pediatrics) Quiz: Ace Your Exams

A 5-year-old boy is brought to the emergency department by his parent for evaluation of left eye swelling for five days and one day of fever. Parent reports the patient hit his eye on a door handle 5 days ago, and since that time, it has had progressively worsening swelling, and today he developed a fever. The patient is otherwise healthy and does not take any daily medications. Temperature is 38.4°C (101°F), blood pressure is 110/67mmHg, pulse is 111/min, respiratory rate is 20/min, and oxygen saturation is 98% on room air. On physical examination, the patient has erythema, swelling of the left upper and lower eyelids, and tenderness around the orbit. There is no bruising around the eye and the left cheek is not flattened. Conjunctiva is normal bilaterally, but the left eye has reduced visual acuity. There is marked pain in the left eye with extraocular movements. The right eye and eyelids are within normal limits. Tympanic membranes are normal bilaterally. Which of the following complications could result if the underlying condition is not identified and treated appropriately?