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Download Periorbital vs Orbital Cellulitis
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PERIORBITAL VS ORBITAL CELLULITIS Morning Report 7/25/12 Melanie McIntosh Anatomy Pathogenesis Rhinosinusitis (especially ethmoiditis) Extension of external ocular infection Stye, dacryocystitis/dacryoadenitis Skin trauma (insect bites, acne, surgery) Dental abscess Hematogenous seeding Epidemiology Periorbital Cellulitis More common overall Age <5yrs M=F Orbital Cellulitis All ages Average: 6.8 yrs 2:1 M>F Associated with sinusitis and URIs More common in winter Clinical Presentation Unilateral erythema, edema, warmth, tenderness of eyelid Fever, systemic illness can be seen Orbital Cellulitis – increased intra-orbital pressure Vision changes (i.e. diplopia) Ophthalmoplegia Proptosis Chemosis Limited EOM Reduced visual acuity Abnormal light reflexes Differential Diagnosis Edema Allergic Reaction Hypoproteinemia Sickle Cell – orbital wall infarction, subperiosteal hematoma Proptosis Orbital Pseudotumor Graves Disease - exophthalmos Diagnostic Work-up Periorbital Cellulitis – typically clinical dx Orbital Cellulitis EOMI Elevated WBC, CRP, ESR (but DO NOT use alone to make the diagnosis!) Wound Culture CT Scan c contrast Edema unable to examine eye CNS involvement Loss of visual acuity, proptosis, ophthalmoplegia Worsening/no improvement after 24-48hrs tx Contrast CT – Orbital Cellulitis Proptosis Intraorbital free air Diffuse fat infiltration Indications for Inpatient Admission Diplopia, loss of visual acuity, abnormal light reflexes, proptosis, ophthalmoplegia CNS Involvement Lethargy, vomiting, HA, seizures, focal deficits, altered mental status Inability to fully examine eye Pathogens 75% Staph & Strep S. epidermidis, S. aureus, S. pyogenes MRSA H. influenza type b S. pneumo Polymicrobial Especially seeding from dental abscess Treatment Periorbital Cellulitis Staph and Strep coverage MRSA PO = IV 7-10 days Should see improvement in 24-48hrs Orbital Cellulitis Coverage for Staph, Strep, and organisms causing rhinosinusitis MRSA 10-14 days Start with IV, but may switch to PO after seeing improvement Surgery Complications – Periorbital Cellulitis Recurrent Periorbital Cellulitis (RPOC) 3 infections within 1 yr, spaced by at least one month Not due to treatment failure Underlying causes Atopy Nonbacterial organisms – HSV, Mycobacteria Collagen Vascular Disorders Structural abnormalities Immunosuppression Complications – Orbital Cellulitis Cavernous Sinus Thrombosis Acute or slowly progressive symptoms of orbital cellulitis Proptosis, Late periorbital edema, and ophthalmoplegia Signs: vision loss, meningismus Intracranial Infections Subdural empyema, Intracerebral abscess, Extradural abscess, Meningitis Optic Nerve Damage – vision loss Septic emboli Compression ischemia
