Question:medium
A two year old child with a long history of purulent nasal discharge and fever now presents with conjunctival congestion and edema. His fever is 102 to 103 F and WBC count is 12,000. The culture of eye discharge was negative. X-rays show opacification of the ethmoid sinus. Which of the following should be the next step in evaluating this patient?
A two year old child with a long history of purulent nasal discharge and fever now presents with conjunctival congestion and edema. His fever is 102 to 103 F and WBC count is 12,000. The culture of eye discharge was negative. X-rays show opacification of the ethmoid sinus. Which of the following should be the next step in evaluating this patient?
Show Hint
Sinusitis with a swollen eye needs CT to tell preseptal from orbital spread and find an abscess.
Updated On: Jun 24, 2026
- CT scan
- Urine culture
- Blood culture
- Repeat culture of eye discharge
Show Solution
The Correct Option is A
Solution and Explanation
Read the trajectory of this illness. A toddler has been running a purulent nose for a while, now spikes a fever, and develops a red, swollen, puffy eye while x rays light up the ethmoid sinus. The ethmoid air cells sit right against the medial wall of the orbit, separated only by a paper thin bone, so an ethmoid infection that pushes into the eye is the textbook setup for orbital cellulitis or a subperiosteal abscess.
The management hinge is anatomical. Is the swelling stuck in front of the orbital septum, or has pus tracked behind it into the orbit and possibly walled off as an abscess? You cannot answer that by looking at the eyelid alone, and a postseptal abscess may need urgent drainage.
That is exactly what a contrast $CT$ of the orbit and sinuses delivers. It maps the sinus disease, distinguishes preseptal from orbital extension, and reveals any collection that the surgeon must evacuate, so it is the logical immediate next step.
The alternatives fall short. A urine culture is irrelevant to a sinus and orbit problem. A blood culture is reasonable supportive testing but is often sterile in a focal orbital infection and tells you nothing about whether an abscess exists. Repeating the conjunctival swab is pointless when the first grew nothing and the real pathology lies deep behind the eye, not on its surface.
\[\boxed{\text{CT scan}}\]
The management hinge is anatomical. Is the swelling stuck in front of the orbital septum, or has pus tracked behind it into the orbit and possibly walled off as an abscess? You cannot answer that by looking at the eyelid alone, and a postseptal abscess may need urgent drainage.
That is exactly what a contrast $CT$ of the orbit and sinuses delivers. It maps the sinus disease, distinguishes preseptal from orbital extension, and reveals any collection that the surgeon must evacuate, so it is the logical immediate next step.
The alternatives fall short. A urine culture is irrelevant to a sinus and orbit problem. A blood culture is reasonable supportive testing but is often sterile in a focal orbital infection and tells you nothing about whether an abscess exists. Repeating the conjunctival swab is pointless when the first grew nothing and the real pathology lies deep behind the eye, not on its surface.
\[\boxed{\text{CT scan}}\]
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