Monday, April 29, 2013

Periorbital Cellulitis

You can read the update here and see pictures of the progress here.
I changed the title from Emily Needs Prayer to the diagnosis because so many parents and hospitals were visiting the page after searching for that term.

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A sinus infection led to periorbital cellulitis.

Emily was hit the hardest by the "nasty mean" strain of flu that hit our entire family hard in early April. She had bronchitis secondary to the flu and that hit her hard as well. She was leaving all of that behind when...

Emily (5) woke up last Tuesday with a swollen eye and a tiny bit of discharge. From previous experience, I figured it was conjunctivitis (pink eye). On Sunday and Monday, I had noted she seemed tired and not as active.

For the last 20 years, Goldenseal eye washes is what has worked very well and very quickly in our family for conjunctivitis. I started those immediately and noticed improvement right away. The discharge stopped and the redness inside the eye left. However, a few hours later, I noticed the pink eye was behaving differently than anything I had seen.

For starters, the skin around her eye turned dark and the texture of the skin was different. Then, her fever spiked to 104.5. Fever does not accompany pink eye. She complained of a severe headache. OTC medicine took the fever down only about a degree, and the headache was still painful. 

Just a short time later, she was complaining of photo sensitivity in her affected eye only and shortly after that, pain in her ear so bad she couldn't lay her head on a pillow. I became alarmed because I have never seen symptoms progress that quickly in any of my children and knew some ugly things it could be. I called Clint, informed him of what was going on, and asked him to take her to a doctor. (I can't drive while on hyperemesis gravidarum medication, and one adult has to be here with the younger children.)

He took her to the local doctor who was open in the evening. Our regular pediatrician keeps office hours only. Dr. Local was concerned because of how quickly it was moving too. He diagnosed it as periorbital cellulitis from a sinus infection secondary to the bronchitis/virus. Because of how quickly it was moving, he gave her an antibiotic shot in the office and prescribed two oral antibiotics and eye drops for the pink eye. The next evening, there was less color in the skin around her eye, her fever was down, swelling was down, and she was feeling better enough to be more active. We thought we had it on the run.

On Thursday, she was back to where she was. We called the doctor's office and told them this. They said to give it more time. On Friday, we told them it looked like she was going a bit backwards still and asked if the culture was in yet. They told us again to wait a little while longer for the antibiotic to work. The culture wasn't back. They told Clint he didn't need to keep calling. They would call us when the results were back. We were calling to update them of her lack of progress and get advice regarding that.  

Today, we took her to our usual pediatrician, who is quite a drive away but worth it. We have a 21+ year history with this doctor who is known for excellence in treating his patients. He is considered the best in the region. The doctors in our area take their children to him.

Cellulitis is when the infection goes into the layers of the skin. On your leg, it isn't such a big deal because there isn't as much there to invade. On the face, there are many things it can invade. The most danger comes when the cellulitis moves behind the eye becoming orbital cellulitis. Orbital cellulitis is much more dangerous and difficult to treat.

Our peditrician confirmed we should have been seeing much more improvement after seven days worth of antibiotics, and he was concerned she was not better. He said she should have improved within 72 hours at the latest. He gave her two shots of strong antibiotics in her legs simultaneously  These are very painful for adults, and she, at 5, was unable to walk for a few hours. He said the dose of one Rx antibiotic was too low, and he would have skipped the eye drops and second antibiotic. 

Right now, we are waiting to see how this shot works. If she doesn't improve a lot by morning, it will tell us that she has a drug resistant strain of bacteria. Dr will call in an older antibiotic to a compounding pharmacy. If she does show improvement, Clint will take her back tomorrow morning where she might receive more shots or be referred to the hospital for x-rays. It all depends on what her body's response to the shots are in the morning.


1. Drug resistant bacteria This is the easiest to treat and he feels very confident the older antibiotic will work.

2. Bad sinus infection in the back of her head working it's way up front These are harder to treat. An x-ray will likely be needed to confirm it.

3. Something very scary that we will not name at the moment to keep everyone from being alarmed It's rare and very unlikely, but on the table. He says if it is this, he feels he can treat it successfully. 

Please pray for Emily. Pray these antibiotics work in a noticeable way by tomorrow morning so we do not have to subject her to more suffering, pain, or testing. Please pray for her doctor to have wisdom to know exactly how to treat it. Say a prayer for the parents of special needs children. I have more admiration for them than ever.