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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.
Which of the following do you think is the most likely diagnosis in this patients?
Orbital cellulitis .
Which is the next diagnostic step to confirm the clinical hypothesis?
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