Orbital and Periorbital Cellulitis Flashcards
Define orbital cellulitis
Infection affecting the fat and muscles posterior to the orbital septum (within the orbit but not involving the globe)
Define periorbital cellulitis
Superficial infection anterior to the orbital septum e.g. eyelids
Risk factors for orbital & periorbital cellulitis
Childhood (mean age hospitalisation 7-12yrs)
Previous sinus infection
Lack of Haemophilus influenzae type b (Hib) vaccination
Recent eyelid infection/insect bite on eyelid (periorbital)
Ear or facial infection
What commonly precedes orbital cellulitis?
Bacterial sinus infection
Clinical features of orbital & periorbital cellulitis
Oedema and erythema around eyelids
Most commonly unilateral
Severe ocular pain
Visual disturbance
Proptosis
Ophthalmoplegia/pain with eye movements
Drowsiness +/- nausea/vomiting in meningeal involvement (rare)
What should bilateral swelling of the eyelids raise suspicion for?
Nephrotic syndrome
What can cause periorbital cellulitis?
Superficial tissue injury e.g. chalazion, insect bite
Investigations for orbital and periorbital cellulitis
FBC – white cells elevated, raised inflammatory markers
CT with contrast– Inflammation of the orbital tissues deep to the septum, sinusitis
Blood culture and microbiological swab to determine the organism
What are the most common bacterial causes of orbital cellulitis?
Streptococcus
Staphylococcus aureus
Haemophilus influenzae B*
What will examination of eye movements show in orbital cellulitis?
Reduced visual acuity
Proptosis
Ophthalmoplegia
Diplopia
Management of orbital cellulitis
Aggressive management
Admission for IV antibiotics
Low threshold for surgical decompression
Management of periorbital cellulitis
Oral antibiotics
Low threshold for IV therapy to prevent progression to orbital cellulitis
Complications of orbital cellulitis
Meningitis (infection backtracking into CNS)
Abscess formation
Cavernous sinus thrombosis
