40. Eye Presentations Flashcards
Outline the pathophysiology of peri-orbital cellulitis
0-15y, >M
Infection of the periorbital soft tissue characterised by erythema and oedema
Pre-septal
Post-septal
Orbital septum - only barrier impeding spread from eyelid into orbit
Typically results from contiguous spread - paranasal sinuses
Streptococcus pneumoniae, Staphylococcus aureus
How does per-orbital cellulitis present?
Pre-septal =
- eyelid oedema
- erythema (upper lid)
- absence of orbital signs
- normal vision, absence of proptosis, full ocular motility, no pain on movement
Post-orbital =
- oedema
- proptosis
- ophthalmoplegia
- decreased visual acuity
- loss of red colour vision – first sign of optic neuropathy
- chemosis
- painful diplopia
How can peri-orbital cellulitis be classified?
The Chandler classification
Type I: Pre-septal cellulitis
Type II: Post-septal, orbital cellulitis
Type III: Subperiosteal abscess
Type IV: Intra-orbital abscess
Type V: Cavernous sinus thrombosis
How should suspected peri-orbital cellulitis be Ix?
Exam =
- General obs
- Dentition
- Anterior rhinoscopy
- Ophthalmic exam (eye movements, colour vision, visual acuity, pupillary response, tonometry, anterior seg biomicroscopy, ophthalmoscopy
- Neuro exam
- Purulent discharge culture
- CT (extension of disease)
Give a DDx for suspected peri-orbital cellulitis
Vesicles of herpes zoster ophthalmicus
Erythematous irritation of contact dermatitis
Raised, dry plaques of atopic dermatitis
Hordeolum or stye
Chalazion
Dacrocystitis
Blepharitits
Outline the ideal Tx for peri-orbital cellulitis
Mild pre-septal = outpatient broad-spec Abx
Post-orbital = admission, IV Abx (gram +ve and -ve)
Supportive = IV fluids, analgesia optic N monitoring
Optic N compromise = emergency drainage of orbital abscess/sinuses
Oral Abx on discharge
What are the possible complications of peri-orbital cellulitis?
Visual = vision loss, residual asymmetrical eyelid opening, impaired ocular motility, eyelid inflam
Life-threatening intracranial = encephalomeningitis, cavernous sinus thrombosis, sepsis, intracranial abscess formation
Outline the aetiology and pathophysiology of conjunctivitis
Disruption of the epithelial layer covering the conjunctiva which can lead to infection
Causes:
- Bacterial = staph aureus, strep pneumonia, H. influenza
- Viral = adenovirus
- Allergens
- Chemicals
- Dirty contact lenses
- Foreign bodies
- Air pollution
- Fungi
What are the signs and symptoms of conjunctivitis?
Redness in the sclera
Swollen conjunctiva
Increased volume of tears
Thick yellow discharge
Green/white discharge from the eye
Itching
Burning
Burred vision
How should conjunctivitis be Ix?
eye exam, swab C+S, rapid adenovirus immunoassay, PCR, ocular pH
How is conjunctivitis best managed?
Self-limiting, Abx (chloramphenicol, fusidic acid)
What are the possible complications of conjunctivitis?
Meningitis, cellulitis, septicaemia, otitis media
