1. Should the diagnosis have been spotted earlier?
Possibly, though in this case there were few ocular clues until the diagnosis was obvious. However, children with ocular pain and a cold should always be considered for the diagnosis of orbital cellultis particularly if the patient has signs/symptoms of sinusitis.

If such patients are discharged with expectant management they should be specifically advised to return if they develop any ocular symptoms.

Usually the diagnosis is not too obvious until the patient develops a red eye, opthalmoplegia, proptosis or decreased visual acuity.

Interestingly this patient did not have a visual acuity tested and this is a significant omission.

2. What is the management?
These usually require surgical drainage by a surgeon competent in orbital surgery.

For more information try:
http://www.revoptom.com/HANDBOOK/SECT7g.HTM
http://www.emedicine.com/oph/topic205.htm