MDT EYE Orbital Cellulitis/ FX

Question 1

_______ is an infection that can affect the skin and/or the eyes.

Answer 1

Cellulitis

Question 2

What kind of infection
(a) Involves soft tissues anterior to the orbital septum
(b) Infections arise from external sockets

Answer 2

Periorbital (Preseptal) cellulitis

Question 3

_______ 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.

Answer 3

Orbital cellulitis

Question 4

True/False
Orbital Cellulitis infections never arise from paranasal sinuses

Answer 4

FALSE
They typically arise paranasal sinuses

Question 5

What are some causes of orbital Cellulitis?

Answer 5

-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).

Question 6

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.

Answer 6

Orbital Cellulitis

Question 7

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.

Answer 7

Ceftriaxone (Rocephin) 2 gram IV

-Amoxicillin/Clavulanate (Augmentin) 875 mg PO BID

Question 8

True/False
Signs of optic neuropathy (e.g., afferent pupillary defect, dyschromatopsia) may be present in severe cases of Orbital Cellulitis.

Answer 8

True

Question 9

What labs/Studies would you do for Orbital Cellulitis?

Answer 9

(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.

Question 10

Treatment for Orbital Cellulitis
True/False
Surgery may be required to drain the paranasal sinuses or orbital abscess.

Answer 10

True

Question 11

True/False
Reevaluate Orbital Cellulitis at least twice daily in the hospital for the first 48 hours

Answer 11

True

Question 12

Clinical improvement of orbital cellulitis may take how long?

Answer 12

24 to 36 hours.

Question 13

What are some complications for Orbital Cellulitis?

Answer 13

(1) Optic neuropathy
(2) Retinal vein occlusion
(3) Severe exposure keratopathy
(4) Cavernous sinus thrombosis
(5) Meningitis
(6) Death

Question 14

A _______ is when there is a break in one of the bones surrounding the eyeball (called the orbit, or eye socket).

Answer 14

orbital fracture

Question 15

Orbital fracture is caused by what?

Answer 15

blunt force trauma

Question 16

What type of Fx affects the bony outer edges of the orbit

Answer 16

Orbital rim fracture

Question 17

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).

Answer 17

True

Question 18

What type of Fx affects the floor or inner wall of the orbit.

Answer 18

Blowout fracture

Question 19

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).

Answer 19

False
Can Pinch the muscles or other structures

Question 20

What type of Fx
Trauma to the orbital rim pushes the bones back, causing the bones of the eye socket floor buckle to downward

Answer 20

Orbital floor fracture

Question 21

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

Answer 21

Orbital Fx

Question 22

What are some ddx for Orbit FX

Answer 22

(1) Orbital edema and hemorrhage without a blowout fracture.
(2) Cranial nerve palsy.
(3) Laceration or direct contusion of the extraocular muscle.

Question 23

What studies would you do for an Orbit Fx

Answer 23

(1) Complete ophthalmic examination.
(2) CT of the orbit, midface and brain.

Question 24

Treatment of Orbital Fx
What prophylactic oral antibiotics to cover sinus pathogens would you use?

Answer 24

(a) Amoxicillin/Clavulanate (500/125 mg TID or 875/125 mg PO BID.)
(b) Azithromycin

Question 25

Treatment of Orbital Fx
What prophylactic oral antibiotics to cover sinus pathogens would you use if the patient has a penicillin allergy?

Answer 25

Doxycycline 100mg BID

Question 26

True/False
You should instruct your pt to blow their nose if they have an Orbital Fracture

Answer 26

FALSE
Instruct the patient not to blow their nose

Question 27

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

Answer 27

30-degree incline when at rest.

Question 28

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

Answer 28

-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.

Question 29

When is IMMEDIATE surgical repair required for an Orbital FX?
When should toe repair be done?

Answer 29

Muscle entrapment with nonresolving bradycardia, heart block, nausea, vomiting, or syncope.

24 to 48 hours

Question 30

True/False
You dont need to medivac an ORbital Fx

Answer 30

FALSE
Neurosurgical, otolaryngology or oral maxillofacial surgery consultation needed

Question 31

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.

Answer 31

in 1 to 2 weeks

Question 32

True/False
Old fractures that have resulted in enophthalmos or hypoglobus can be repaired at any later date.

Answer 32

True