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Periorbital cellulitis - please help!

56 replies

Iflippinghateplaydoh · 31/03/2019 22:51

Ds (3yo) went to bed Friday night with a very slightly swollen eye.
Saturday morning-completely swollen. No pain just wouldn't open.
Out of hours gp gave eyedrops for conjunctivitis whilst telling me "I'm not sure that it is conjunctivitis" Angry
Today (Sunday) ds wakes up crying. His eye is purple, swollen, closed over and he is saying his head is hurting and temp of 40. Call 111. Sent to out of hours who immediately sends us to a&e. All rushed through very fast and within 20 mins we are up on a ward he has numbing cream on his hand ready for iv antibiotics. Doctor goes off and speaks to consultant and between them decide they think it is periorbital cellulitis and not orbital and give oral antibiotics 3x a day for 10 days. We were under strict instructions return straight to the ward if we have any concerns that things are worsening or not improving fast enough just call ahead first.
We left hospital at 1pm and ds has slept since then. He won't eat (hasn't since tea yesterday) and just keeps crying saying his head is hurting. He's had 2 doses of antibiotics and his temperature has been 38.3 at lowest all day despite regular Calpol and Nurofen.
I am worried so I called the ward and she completely shot me down, saying that I've allowed no time for medicine to kick in yet. I'm also worried about the diagnosis being wrong as everything I've read (I know, I know) says that periorbital comes from a cut or a bite etc but ds had absolutely no signs of anything like that. He's had a cough and a snotty nose for a couple of days prior.
Would you go back tomorrow or should I allow longer for the meds to work? The eye DOES look less swollen tonight as in he is able to open a couple of mm, but it's the lethargy, temperature (currently 39) and the lack of appetite that are making me worry.

OP posts:
CharlesChickens · 01/04/2019 00:10

Op if you feel unhappy with their advice then just go in with him. I know it is horrible to drag a very unwell toddler out at night, but if your instincts are to get him seen again then just take him. If i had listened to my Gp then my dd could have got much more unwell. We caught it just in time.
Peri orbital cellulitus is serious, and as he is so off colour then I don’t think you are over-reacting being very worried.

Miljah · 01/04/2019 00:13

We have had peri orbital cellulitis, a couple of times. DS1 (now 19) had flare ups of cysts in his cheek from cystic acne that made his eye look like the OP's photo!

On both occasions, oral antibiotics turned the corner quickly.

I advise my DSs to use the term 'peri-orbital cellulitis' to get the HCP to sit up and take notice, tho.

CharlesChickens · 01/04/2019 09:26

Worrying about your little boy this morning op, I hope things are ok and that he has either been or is improving.

Nogodsnomasters · 01/04/2019 09:44

How was your night op? The pic of your ds is absolutely heartbreaking. I really really hope he's had an improvement this morning.

Iflippinghateplaydoh · 01/04/2019 10:12

Hi everyone. He is a lot better this morning. The eye is swollen but he can open it a lot more, he's eaten breakfast also. Temp still up at 39.7 but he's not as lethargic. I guess I just need to give it time as things have Definately got better. Thank you:-)

OP posts:
CharlesChickens · 01/04/2019 10:18

That is very good news op, what a relief.

MoonlitCastle · 01/04/2019 10:22

Glad to hear it Smile

Nogodsnomasters · 01/04/2019 10:28

I am glad to hear that op, I'm sure you're relieved. Don't hesitate to ring the ward again if you can't get his temp to stay down with meds though.

Iflippinghateplaydoh · 01/04/2019 10:32

That's how it looks today

Periorbital cellulitis - please help!
OP posts:
ScarlettSahara · 01/04/2019 12:32

Thanks for the update - glad to be proved wrong. His eye looks vastly improved!

TapasForTwo · 01/04/2019 12:42

Oh, bless him. I hope he feels much better soon. What a worry Flowers

TuckMyWin · 01/04/2019 12:51

I'm astounded that wasn't treated with IV AB's. My youngest has had periorbital twice, and I have a friend whose son also had it, and it looked in all of those cases nowhere near as bad as your son's. My friend's son was treated with IV AB's even though it was periorbital. I'm also amazed the first OOH GP didn't spot it, both myself and my friend were sent straight to eye A&E at first sight of a swollen eye with no obvious gunk as you would get with conjunctivitis. None of that is helpful to you, and I'm
really glad your son is getting better on the oral AB's, but I guess what I'm trying to say is that you should still keep a really close eye on him as , even now, let alone yesterday, that's a really bad case of periorbital cellulitis, IME.

Toddlerteaplease · 01/04/2019 13:27

OMG I'm a paediatric nurse and we have kids with this a lot on my ward. I am horrified that you've been sent home with orals! Go back to The hospital and insist on IV. I'm about to discharge a child with a far less swollen eye than that!

Toddlerteaplease · 01/04/2019 13:28

I totally agree with the doctor who posted earlier.

Iflippinghateplaydoh · 01/04/2019 13:29

@toddlertea even though the swelling has gone down? He's still not himself, he's had diarreoah twice quite badly which he has never had ever believe it or not (never been sick either!). He ate breakfast but no lunch. Is playing but very pale

OP posts:
SirVixofVixHall · 01/04/2019 19:33

Take him back in. That doesn’t sound right ( although the diarrhoea is normal on antibiotics) .

Nogodsnomasters · 01/04/2019 19:34

Has his temp come down op? If not I would do as pp nurse has advised and ring the ward again.

Schuyler · 01/04/2019 19:50

Oh poor little man. :( I was sent home with an eye like that, I was given oral antibiotics but I’m an adult. The antibiotics are probably making him feel crummy, try to encourage him to eat. Take him straight back to A&E if you’re still worried.

Lougle · 01/04/2019 20:13

DD1 had periorbital cellulitis. I took her to the GP who took one look and said "I'm just going to make a phonecall." DD1 said "no needles..." and as I said "no, no DD1, no needles..." The GP looked at me and subtly motioned to her arm, with a jabbing motion!

DD1 had 3 days of IV antibiotics as an ambulatory patient (admitted to the ward, but allowed home between doses).

Periorbital cellulitis - please help!
Lougle · 01/04/2019 20:15

Her eye isn't maybe as clear in that photo, but it was massive! In the end, when it all went down, I found a teeny tiny 2mm graze next to her eye, which must have been from a nail tag as she wiped her face.

SnapesGreasyHair · 01/04/2019 20:27

How are things OP?

Toddlerteaplease · 01/04/2019 22:22

@Iflippinghateplaydoh it does look much better but not completely better. I am absolutely appalled that he wasn't given IVABs. Has he got nose drops?
Is your hospital a fairly small one? I.e not a teaching hospital?
The diarrhoea is almost certainly Antibiotic related.

Iflippinghateplaydoh · 01/04/2019 22:24

Thanks for all this info guys it's been really reassuring!
He is okay-ish. No temp since this afternoon and swelling is now right down.
4 bouts of diarreoah and hasn't eaten since breakfast, wouldn't touch lunch or dinner (he requested beans on toast then sat there and cried :-( ) . He also has been very lethargic again and slept 2-5pm then back to bed at 6.30.
I'd say the antibiotics are Definately working due to reduced swelling and temperature. Just need to get the drowsiness, tummy troubles and food issues sorted now! Keeping him off nursery tomorrow of course :-)

OP posts:
Iflippinghateplaydoh · 01/04/2019 22:25

@toddlertea it's not a teaching hospital but still a big Midlands hospital! No nasal drops, just 3 x co-amoxiclav a day for 10 days

OP posts:
Iflippinghateplaydoh · 01/04/2019 22:26

2.5ml three times a day

OP posts:
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