sty or not sty

[greenboy]

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two days ago we got this 45 years old black male with what it seems an sty on his left upper eyelid. My coworker prescribed keflex and warm towels and sent him back home. Today I saw him, the eye lid it's worst, but now the swelliness is all around the eye and include part of the upper nose. I looks more like an allergic reaction at this time than anything else. I did not change his treatment and he is schedule for a shot of benadryl this morning.

any suggestion what are we doing wrong here??

 

[WallowaWanderer]

Sounds like a periorbital cellulitis extending from the hordeolum. Your Keflex should do just fine but I would re-check him in another 24 hours. That's my thought.

And I don't think that "swelliness" is a word. It's "swollen" or "swelling" or "edematous" or "edema"

 

[Janders]

Sounds worrisome for peri-orbital vs. orbital cellulitis from your limited description. Any worry that Keflex may not cover the bug? (known MRSA carrier?). Any worry that it could be orbital? Any concern he could use IV abx (HIV, diabetes?)

Why would he have a localized "allergic reaction"?

He at least needs consistent follow-up so if it worsens...

 

[Winged Scapula]

Swelliness.

I like it. Almost "Colbertian" in its simplicity.

 

[totalbodypain]

Sounds worrisome for peri-orbital vs. orbital cellulitis from your limited description. Any worry that Keflex may not cover the bug? (known MRSA carrier?). Any worry that it could be orbital? Any concern he could use IV abx (HIV, diabetes?)

Why would he have a localized "allergic reaction"?

He at least needs consistent follow-up so if it worsens...

Seeing as the rates of CAMRSA in many urban centers is approaching 50% or greater I would have gone for better coverage. Bactrim, clinda, doxy seem to be most useful with CAMRSA (adjusted for local flora and resistance patterns of course). Sounds like he may have an admission and some IV bug juice slated in his near future. The diagnosis of sensitivity reaction sounds a bit sketchy especially considering the potential danger if the cellulitis does advance beyond just a mild periorbital cellulitis. (infection in eye=bad juju and a trip to your local med mal defense lawyer).

 

[docB]

Sounds worrisome for peri-orbital vs. orbital cellulitis from your limited description.

Sounds worrisome for someone who is peripherally associated with health care seeking medical advice.

 

[Janders]

Perhaps I should have had my trolliness detectors set on a higher setting...