Orbital and periorbital cellulitis Flashcards
What is periorbital cellulitis?
An eyelid and skin infection in front of the orbital septum
What is the investigation of periorbital cellulitis?
Urgent ophthalmology referral for assessment to distinguish from orbital cellulitis
CT scan is performed
What is the treatment of periorbital cellulitis?
Oral antibiotics - usually co-amoxiclav
What is orbital cellulitis?
Infection of the tissues contained within the orbital cavity (behind the orbital septum)
What is orbital cellulitis most commonly caused by?
Streptococcal and staphylococcal species
How does orbital cellulitis develop?
Infection can be spread from:
- Peri-orbit
- URT
- Sinuses
- Lacrimal sac
What are the risk factors for orbital cellulitis?
Young age
URTI
Sinusitis
Trauma
Immunosuppression
Lack of HiB vaccine
Periorbital cellulitis
Ear infection
What is the presentation of orbital cellulitis?
Swelling and redness of eyelids
Pain on ocular movement
Diplopia
Fever
Proptosis
Reduced visual acuity
Ptosis
Chemosis
What are the differentials of orbital cellulitis?
Periorbital cellulitis
Cavernous sinus thrombosis
Acute blepharitis
How is orbital cellulitis differentiated from periorbital cellulitis?
The following features are not seen in periorbital cellulitis:
- Reduced visual acuity
- Proptosis
- Ophthalmoplegia with eye movements
What investigations are used in the diagnosis of orbital cellulitis?
CT with contrast
Blood cultures
Microbiological swab
VBG - assess for sepsis
FBC
CRP
What is the management of orbital cellulitis?
Admit to hospital
IV antibiotics
- Co-amoxiclav or ceftriaxone
- Clindamycin + metronidazole if penicillin allergic
Analgesia
What is the surgical management of orbital cellulitis?
Surgical drainage and sinus washout
Lateral canthotomy - cutting the corner of the eye to relieve pressure
