A19-month-old boy presents with a 1 -day history of left eyelid- swelling. The swelling is greater in the lower lid and accompanied by local erythema, tenderness, and temperature up to 38.4°C. His parents state that he has decreased appetite and activity. For the past week, the boy has been experiencing clear, watery rhinorrhea, sneezing, and a mild cough. Today, he was given diphenhydramine without any improvement of the eyelid swelling. His parents deny any history of trauma or recent insect bites to the face. The past medical history is significant for mild intermittent asthma and allergic rhinitis. He is exposed to tobacco at home.On physical examination, the child appears ill, but not toxic. His temperature is 36.9°C, heart rate is 123 beats/min, respiratory rate is 26 breaths/min, and blood pressure is 117/82 mm Hg. Both upper and lower left eyelids appear significantly edematous, with surrounding erythema and tenderness to light touch. No chemosis or proptosis is apparent. Extraocular movements and visual acuity can be evaluated only partially due to pain.
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