A 17 year old boy was assaulted with a skateboard, from which he sustained a laceration to his forehead and below his left eye. His wounds were closed primarily in accident and emergency and he was given a course of oral flucloxacillin. He returned to the department two days later having become increasingly unwell with lethargy, fever, and marked swelling with tenderness over the left lower eyelid.

On examination he had a tachycardia of 120 and a pyrexia of 38.9. He had mild chemosis of the left eye with a …