Cellulitis Flashcards
Describe cellulitis?
Cellulitis is an inflammation/infection of circutaneous connective tissue of skin
Preseptal = in front of orbital septum
Orbital septum: in most cases this is a physical divide from superficial skin area & things further back – orbital fat and everything that extends from there back to the brain -> v important defense mechanism – it is the separation from the outside world & the brain
If have an infection want it to stay in front of the orbital septum
Describe preseptal cellulitis and its causes?
- Infection of orbital tissues anterior to orbital septum
- Causes:
o Trauma – in or around eye – can pose break in barrier of skin & skin infection can occur
o Spread of infection from nearby structures – e.g. hordeolum, dacrocystitis, recent eye surgery
o Spread of remote infection – e.g. upper respiratory tract infection, impetigo, recent surgery around eye -> something not affecting eye but affecting area around eye
What are the symptoms of preseptal cellulitis?
- Unilateral – due to the causes
- Red tender swelling around eye – sometimes struggle to open eye
- Unwell px – fever, malaise, irritable child (if they cannot articulate how they’re feeling)
What are the signs of preseptal cellulitis?
- Lid oedema, warmth, tenderness, ptosis
- Fever
- Px’s VA, pupils etc not usually affected
Preseptal cellulitis generally does not affect the structures within the eye itself – just swollen eyelid that you get
Location of swelling is all at front – in front of orbital septum
What is the management of preseptal cellulitis by optometrists and by hospital?
- Management by community optometrist:
o CMG: “Emergency (same day) referral to ophthalmologist or A&E departments, no intervention”
Risk of misdiagnosis as orbital cellulitis - Hard to differentiate – especially if px cannot fully open their eye an so you are not easily able to complete necessary tests
- Management by hospital (ophthalmologist, possible aided by optometrist/orthoptist):
o Confirmation of diagnosis, CT scan – to see where area of infection/inflammation is
o Systemic antibiotics (usually oral) – don’t want the infection to get any worse
Describe orbital cellulitis and the causes?
- Infection of orbital tissue behind orbital septum – could spread all way back to brain causing a serious or life-threatening event
- Causes:
o Spread of remote infection
Sinus infection – most common – could be cold/sinusitis that spreads
Mid-facial infection
Dental infection
o Post-trauma (48-72hrs) – often less superficial trauma
o Post-surgical – these pxs will often be under hospital supervision anyway
What are the symptoms /signs of orbital cellulitis?
- Tends to be more severe than preseptal but this is a sliding scale & may not always help differentially diagnose
o Much more angry, tender, warmer situation - Swollen, red, warm & tender eyelids
o V often the px cannot open the eye at all (to check VA etc) - Proptosis – infection/inflammation in the structures behind the eye pushing eye forward
- Restricted & painful eye movements
o If they can open their eye – can get them to look R & L
o If able to motility, eye movements may be restricted - Optic nerve dysfunction (advanced):
o Pupil reactions likely to be affected – v severe then direct response could be affected – if less severe then likely to have RAPD in affected eye
o VA
o Colour vision - Rapid onset
- Severe malaise & fever
What is the management of orbital cellulitis by an optometrist and by hospital?
- Management by community optometrist:
o CMG: “Emergency (same day) referral to ophthalmologist or A&E department, no intervention” - Management by hospital (ophthalmologist, possibly aided by optometrist/orthoptist):
o Confirmation of diagnosis, CT scan, blood tests
o Admission to hospital
o Systemic antibiotics (IV) – because infection really needs controlled
Kept under really close supervision
There is often a grey area between the 2 – hard to tell in children who can’t articulate how they are feeling
