Differential Diagnosis for Peri-Orbital Swelling in a 2-Year-Old

Single Most Likely Diagnosis

• Allergic Rhinitis: This is a common condition in children that can cause peri-orbital swelling, especially in the mornings due to overnight accumulation of fluid. Allergies to dust mites, pet dander, or other environmental allergens are typical triggers.

Other Likely Diagnoses

• Upper Respiratory Infection: Viral infections can lead to sinus congestion and subsequent peri-orbital swelling.
• Sinusitis: Given the age of the child, sinusitis could be a consideration, especially if there are other symptoms like nasal discharge or cough.
• Dental Infection: An infection of the teeth or gums can spread and cause swelling around the eye.

Do Not Miss Diagnoses

• Orbital Cellulitis: A serious infection that requires prompt antibiotic treatment to prevent complications like vision loss or intracranial infection.
• Retinoblastoma: Although rare, this is the most common primary malignant intraocular tumor in children, and any persistent or unexplained swelling around the eye warrants a thorough investigation.
• Neuroblastoma: This cancer can cause proptosis or peri-orbital swelling if it metastasizes to the orbits.

Rare Diagnoses

• Wegener's Granulomatosis (Granulomatosis with Polyangiitis): A rare autoimmune disorder that can cause a variety of symptoms including peri-orbital swelling.
• Thyroid Ophthalmopathy: Although more common in adults, it can occur in children and cause swelling around the eyes due to autoimmune thyroid disease.
• Lymphangioma: A rare congenital condition that can cause peri-orbital swelling due to abnormal lymphatic vessels.