An 8-year-old boy with a medical history of allergic rhinitis presents to the emergency department (ED) with 2 weeks of nasal congestion, watery eyes, and acute onset of right eye protrusion. Associated symptoms include sensitivity to light and green drainage from the right eye that started 3 days ago. At the onset of eye discharge, he initially presented to an urgent care center, where he was diagnosed as having conjunctivitis and treated with erythromycin ointment; eye discharge improved with treatment and resolved before presentation in the ED. At follow-up with the pediatrician, he was noted to have right eye proptosis, prompting emergency referral to the ED.

In the ED, he and his mother deny fever, headache, blurry vision, eye pain, and rashes and erythema around the eye. He also denies trauma. He has not experienced nausea, vomiting, weight loss, epistaxis, or bruising. His medical history is significant for peanut allergy,...

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