MDT EYE Orbital Cellulitis/ FX Flashcards
_______ is an infection that can affect the skin and/or the eyes.
Cellulitis
What kind of infection
(a) Involves soft tissues anterior to the orbital septum
(b) Infections arise from external sockets
Periorbital (Preseptal) cellulitis
_______ affects the eye socket (called the orbit). This form of cellulitis can cause the eye or eyelid to swell, keeping the eye from moving properly.
Orbital cellulitis
True/False
Orbital Cellulitis infections never arise from paranasal sinuses
FALSE
They typically arise paranasal sinuses
What are some causes of orbital Cellulitis?
-Direct extension from a paranasal sinus infection especially ethmoiditis,
-Sequela of orbital trauma (e.g., orbital fracture, penetrating trauma, retained intraorbital foreign body).
-Sequela of eyelid, orbital, or paranasal sinus surgery
-Sequela of other ocular surgery (less common).
Patient has these issues what would you suspect?
-Red eye, pain with eye movement, blurred vision, double vision, eyelid and/or periorbital swelling, nasal congestion/discharge, sinus headache/pressure/congestion, tooth pain, infra- and/or supraorbital pain, or hypesthesia.
-Eyelid edema, erythema, warmth, and tenderness. Conjunctival chemosis and injection, proptosis, and restricted extraocular motility with pain on attempted eye movement are usually present.
Orbital Cellulitis
ON A SHIP
Patient has these issues what antibiotic would you give?
-Red eye, pain with eye movement, blurred vision, double vision, eyelid and/or periorbital swelling, nasal congestion/discharge, sinus headache/pressure/congestion, tooth pain, infra- and/or supraorbital pain, or hypesthesia.
-Eyelid edema, erythema, warmth, and tenderness. Conjunctival chemosis and injection, proptosis, and restricted extraocular motility with pain on attempted eye movement are usually present.
Ceftriaxone (Rocephin) 2 gram IV
-Amoxicillin/Clavulanate (Augmentin) 875 mg PO BID
True/False
Signs of optic neuropathy (e.g., afferent pupillary defect, dyschromatopsia) may be present in severe cases of Orbital Cellulitis.
True
What labs/Studies would you do for Orbital Cellulitis?
(1) History (trauma, surgery, infection)
(2) Complete ophthalmic examination.
(3) CT scan of the orbits and paranasal sinuses.
(4) CBC with differentia, blood cultures, gram stain and culture of any drainage.
(5) Explore and debride any penetrating wound.
Treatment for Orbital Cellulitis
True/False
Surgery may be required to drain the paranasal sinuses or orbital abscess.
True
True/False
Reevaluate Orbital Cellulitis at least twice daily in the hospital for the first 48 hours
True
Clinical improvement of orbital cellulitis may take how long?
24 to 36 hours.
What are some complications for Orbital Cellulitis?
(1) Optic neuropathy
(2) Retinal vein occlusion
(3) Severe exposure keratopathy
(4) Cavernous sinus thrombosis
(5) Meningitis
(6) Death
A _______ is when there is a break in one of the bones surrounding the eyeball (called the orbit, or eye socket).
orbital fracture
Orbital fracture is caused by what?
blunt force trauma
What type of Fx affects the bony outer edges of the orbit
Orbital rim fracture
True/False
Because the rim is made up of very thick bone, an injury to this area has to carry a lot of force for a fracture to occur (car accidents).
True
What type of Fx affects the floor or inner wall of the orbit.
Blowout fracture
Blowout FX: True/FAlse
Crack in the very thin bone that makes up these walls doesn’t pinch muscles and other structures (Getting hit with a baseball or a fist).
False
Can Pinch the muscles or other structures
What type of Fx
Trauma to the orbital rim pushes the bones back, causing the bones of the eye socket floor buckle to downward
Orbital floor fracture
Pt has theses issues what would you suspect?
(a) Pain on attempted eye movement and local tenderness.
(b) Eyelid edema
(c) Crepitus (particularly after nose blowing)
(d) Binocular diplopia
(e) Numbness of the cheek, upper lip, and/or teeth
(f) Acute tearing is usually due to ocular irritation
Orbital Fx
What are some ddx for Orbit FX
(1) Orbital edema and hemorrhage without a blowout fracture.
(2) Cranial nerve palsy.
(3) Laceration or direct contusion of the extraocular muscle.
What studies would you do for an Orbit Fx
(1) Complete ophthalmic examination.
(2) CT of the orbit, midface and brain.
Treatment of Orbital Fx
What prophylactic oral antibiotics to cover sinus pathogens would you use?
(a) Amoxicillin/Clavulanate (500/125 mg TID or 875/125 mg PO BID.)
(b) Azithromycin
Treatment of Orbital Fx
What prophylactic oral antibiotics to cover sinus pathogens would you use if the patient has a penicillin allergy?
Doxycycline 100mg BID
True/False
You should instruct your pt to blow their nose if they have an Orbital Fracture
FALSE
Instruct the patient not to blow their nose
Pt has theses issues; what angle should they attempt to be when at rest?
(a) Pain on attempted eye movement and local tenderness.
(b) Eyelid edema
(c) Crepitus (particularly after nose blowing)
(d) Binocular diplopia
(e) Numbness of the cheek, upper lip, and/or teeth
(f) Acute tearing is usually due to ocular irritation
30-degree incline when at rest.
Pt has theses issues what meds would you give?
(a) Pain on attempted eye movement and local tenderness.
(b) Eyelid edema
(c) Crepitus (particularly after nose blowing)
(d) Binocular diplopia
(e) Numbness of the cheek, upper lip, and/or teeth
(f) Acute tearing is usually due to ocular irritation
-Prophylactic oral antibiotics to cover sinus pathogens
-Augmentin
-Azithromycin
-Nasal decongestants (afrin BID for 3 days)
-Apply ice packs to the eyelids for 20 minutes every 1 to 2 hours for the first 24 to 48 hours and attempt a 30-degree incline when at rest.
-Consider oral corticosteroids.
When is IMMEDIATE surgical repair required for an Orbital FX?
When should toe repair be done?
Muscle entrapment with nonresolving bradycardia, heart block, nausea, vomiting, or syncope.
24 to 48 hours
True/False
You dont need to medivac an ORbital Fx
FALSE
Neurosurgical, otolaryngology or oral maxillofacial surgery consultation needed
When can the patient had a surgical repair?
1) Persistent, symptomatic diplopia in primary or downgaze.
2) Large orbital floor fractures (>50%).
3) Large combined medial wall and orbital floor fractures.
4) Complex trauma involving the orbital rim, midface or skull base.
5) Nasoethmoidal complex fractures.
6) Superior or superomedial orbital rim fractures involving the frontal sinuses.
in 1 to 2 weeks
True/False
Old fractures that have resulted in enophthalmos or hypoglobus can be repaired at any later date.
True
