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Opthalmology > Infective eye disease > Flashcards

Infective eye disease Flashcards

1
Q

What is orbital cellulitis?

A

Severe sight- and life-threatening emergency due to infection of soft tissues posterior to the orbital septum

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2
Q

Where does orbital celluitis infection normally spread from?

A
  • Extension of infection from periorbital structures - ethmoid sinusitis, face, globe, lacrimal sac or dental infection
  • Direct inoculation of orbit from trauma
  • Haematogenous spread from distant bacteraemia
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3
Q

What is classified as the orbital septum?

A

In the upper eyelid, the orbital septum blends with the tendon of the levator palpebrae superioris, and in the lower eyelid with the tarsal plate

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4
Q

What parts of the orbit does orbital cellulitis affect?

A
  • Extraocular muscles
  • Fatty tissues
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5
Q

What are the most commonly implicated organisms in orbital cellulitis?

A
  • Streptococcus pneumoniae
  • Staphylococcus aureus
  • Streptococcus pyogenes
  • Haemophilus influenzae
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6
Q

What are symptoms of orbital cellulitis?

A

Unilateral, rapid onset

  • Erythema
  • Swelling
  • Severe pain
  • Blurred vision
  • Diplopia
  • Headache
  • Systemic features
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7
Q

What are systemic features seen in Orbital cellulitis?

A
  • Fever
  • Malaise
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8
Q

What are signs of orbital cellulitis?

A
  • Lid erythema + chemosis
  • Reduced periorbital sensation
  • Pain
  • Reduced visual acuity
  • Proptosis
  • Painful opthalmoplegia
  • Optic neuropathy
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9
Q

Why do those with orbital cellulitis get opthalmoplegia?

A

Inflammation of extra-ocular muscles

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10
Q

How is orbital cellulitis staged?

A

Chandlers Classficiation - stage I-V

  • Stage I - Preseptal
  • Stage II - Orbital
  • Stage III - sibperiosteal abscess
  • Stage IV - Orbital abscess
  • Stage V - Cavernous sinus thrombosis and infection
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11
Q

What is stage I of chandler’s classification of orbital cellulitis?

A

Preseptal cellulitis

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12
Q

What is stage II of chandler’s classification of orbital cellulitis?

A

Orbital cellulitis

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13
Q

What is stage III of chandler’s classification of orbital cellulitis?

A

Subperiosteal abscess

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14
Q

What is stage IV of chandler’s classification of orbital cellulitis?

A

Orbital Abscess

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15
Q

What is stage V of chandler’s classification of orbital cellulitis?

A

Cavernous sinus thrombosis and infection

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16
Q

How would you clinically assess someone with suspected peri-orbital/orbital cellulitis?

A

Distinguish between the two and assess for features of orbital cellulitis

  • Painful eye movements?
  • Reduced Visual acuity/Blurriness?
  • Diplopia?
17
Q

What investigations would you consider in someone with periorbital/orbital cellulitis?

A
  • Bloods - septic screen
  • Consider CT
18
Q

What are indications for CT scan for someone with peri-orbital cellulitis?

A
  • Central Signs
  • Unable to assess vision
  • Gross proptosis
  • Bilateral oedema
  • Opthalmoplpegia
  • Deteriorating visual acuity
  • No improvement at 24 hours
19
Q

Why doesn’t everyone with peri-orbital/orbital cellulitis get a CT scan?

A

Significant radiation exposure in young population - therefore more risk than benefit unless clinical picture indicative of orbital cellulitis

20
Q

What are the main complications of orbital cellulitis?

A
  • Exposure keratopathy
  • Raised intraocular pressure
  • Central retinal artery/vein occlusion
  • Endophthalmitis
  • Optic neuropathy
  • Orbital abscess
  • Meningitis
  • Brain abscess
  • Cavernous sinus thrombosis.
21
Q

What is CT used to visualise in orbital cellulitis?

A

Sinuses, orbit and brain - looking for abscesses and cavernous sinus thrombosis

22
Q

What is peri-orbital cellulitis?

A

Infection of the soft tissue anterior to the orbital septum, which is commonly caused by sinusitis or facial skin lesions

23
Q

What is the main feature of periorbital cellulitis?

A

Erythematous swelling around the eyelid

24
Q

How would you manage peri-orbital cellulitis?

A

Empirical antibiotics - amoxicillin/ceftriaxone for 10 days

25
Q

How would you manage orbital cellulitis?

A

Admit to hospital

  • ENT and opthalmology referral
  • CT orbit and sinuses
  • IV Antibiotics - Ceftriaxone + Metranidazole +/- vancomycin
  • Monitor optic nerve function - every 4 hours
26
Q

How often would you monitor optic nerve function in someone with orbital cellulitis?

A

Every 4 hours

27
Q

How would you manage an orbital abscess?

A

Surgical drainage

Opthalmology (12 decks)

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