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Acute bilateral eyelid swelling in a 5-year-old child
  1. Sara Romano1,
  2. Andrea Taddio1,2,
  3. Massimo Maschio2,
  4. Egidio Barbi1,2,
  5. Fulvio Parentin2
  1. 1 Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
  2. 2 Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
  1. Correspondence to Dr Sara Romano, Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy; sara.romano17{at}gmail.com

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A healthy 5-year-old boy presented with a 10-day history of painless, swollen and hyperaemic eyelids without conjunctival injection or fever. Baseline blood tests including inflammatory markers were unremarkable except for mild raised levels of erytrocyte sedimentation rate (38 mm/hour). Physical examination was totally negative with no sign of sinusitis. During the recovery, 3 days after the admission, an orthoptic evaluation showed bilateral upper eyelid ptosis (figure 1) and painful extrinsic ocular movements, with a restriction of upgaze in both eyes. Biomicroscopy showed conjunctival hyperaemia and chemosis; fundus oculi was normal.

Figure 1

Bilateral upper painless swollen and hyperaemic eyelids with associated ptosis.

Question 1

Which of the following do you think is the most likely diagnosis in this patients?

  1. Orbital cellulitis .

  2. Orbital myositis.

  3. Thyroid orbitopathy.

  4. Myasthenia gravis.

Question 2

Which is the next diagnostic step to confirm the clinical hypothesis?

  1. Orbital biopsy.

  2. CT.

  3. MRI.

  4. Visual …

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