Eye-lid you not…eye cannot move

Author: Mrudula Utukuri / Editor: Sarah Edwards / Codes: / Published: 29/09/2022

A 5-year-old girl presents to the Emergency Department (ED) with the right eyelid swelling. Her father tells you that this has been worsening over the last 3 days and she is now feverish. He also mentions that for the last week his daughter has had a blocked nose with facial pain. She has no other past medical or ocular history, and she does not take any regular medications. She has no allergies. She has not been vaccinated.

On examination, she looks unwell. Her right eye is shown in Figure 1. She is unable to open her right eyelid and has restriction of eye movements in all directions of gaze.

Her observations are RR 16, SpO2 100% on air, BP 118/75, HR 98, Temp 38. The rest of her systemic examination is normal.


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