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

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A 7-year-old boy is brought to the emergency department for evaluation of left eye pain and swelling for five days. The patient has no significant medical history and is otherwise healthy. Temperature is 38.3 F°C (101°F), blood pressure is 111/72mmHg, pulse is 125/min, respiratory rate is 20/min, and oxygen saturation is 99% on room air. On physical examination, the patient is oriented to person, place, and time and answers questions appropriately. There is soft tissue swelling and erythema around the left orbit with associated proptosis and chemosis. The patient has evidence of decreased visual acuity and ophthalmoplegia. The rest of the neurological exam is nonfocal. The patient is started on ceftriaxone and vancomycin. Ophthalmology is consulted. Which of the following is the best next step in management?

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