Question

An 8-year-old boy presents for evaluation with a 3-day history of fever, lethargy, and _______. On examination, the child appears uncomfortable. He is found to have 20/20 vision with his right eye and 20/40 vision in his left eye. Although the patient has full ocular motility with his right eye, there is proptosis and limitation of ocular motility with his left eye. The child also expresses pain in his eye on ocular motility examination. Which of the following is the most appropriate initial step in treatment?

1) Antibiotic therapy
2) Elevation of the head of the bed
3) Intravenous corticosteroids
4) Ophthalmology consultation

Answer 1

The most appropriate initial step in the treatment is to obtain an 4) ophthalmology consultation due to the serious nature of the child's symptoms, which may indicate an orbital infection or another serious condition.

Step-by-step explanation:

The most appropriate initial step in the treatment of a child presenting with fever, lethargy, proptosis, limitation of ocular motility, and pain on eye movement is to obtain an ophthalmology consultation. These symptoms are indicative of a serious eye condition that requires immediate specialist assessment. Possible underlying conditions could range from an orbital infection, like orbital cellulitis, which would require urgent antibiotic treatment, to more serious conditions such as a space-occupying lesion causing increased intraorbital pressure. An ophthalmologist is best equipped to evaluate these symptoms and facilitate the necessary diagnostic imaging, such as MRI or CT scans, which can guide further management.