A 4-year-old girl with sickle cell trait presented to the emergency department (ED) with an 11-day history of redness, swelling, and droopiness of the right eye. The pediatrician initially diagnosed the child as having periorbital cellulitis, prescribed amoxicillin-clavulanic acid, and referred her to an ophthalmologist. On ophthalmologic evaluation she was found to have mild upper lid proptosis; funduscopic examination findings were normal. A maxillofacial computed tomographic (CT) scan showed normal extraocular muscles and optic nerve, with minimal subcutaneous soft tissue swelling along the right eyelid and intra-orbital fat bilaterally consistent with preseptal cellulitis.

On presentation to the ED, she had completed 7 days of antibiotic drug treatment. She had normal findings on physical examination, with no ptosis, anisocoria, afferent pupillary defect, or neurologic deficit and was discharged, with outpatient neurology follow-up the following day. At that time, she was noted to have right eye ptosis with down and out position...

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