Orbital cellulitis Flashcards
What are the causes of orbital cellulitis?
- Most commonly secondary to ethmoidal sinusitis (through lamina papyracea)
- poorly controlled DM, immunocompromised
- Infection of adjacent structures (facial, dacryocystitis, dental abscess, URTI)
- Trauma or surgical (orbital, lacrimal)
what are the organisms that can cause orbital cellulitis?
Staph. aureus, Strep. pneumoniae, Strep. pyogenes, Haemophilus influenza
what is orbital cellulitis?
inflammation of the soft tissues of the eye socket behind the orbital septum, a thin tissue which divides the eyelid from the eye socket
what is preseptal cellulitis?
infection of subcutaneous tissues anterior to the orbital septum
what are the symptoms of orbital cellulitis?
- Painful red eye, with lid oedema in a child with a recent URTI is the typical presentation of orbital cellulitis.
- Acute onset
- Periorbital swelling & redness
- Pain
- Visual – blurring, diplopia
- Systemic – fever, malaise, toxic, may have preceding symptoms of sinusitis (e.g. facial pain, rhinorrhoea)
what are the signs of orbital cellulitis?
C – Chemosis and severe injection of the conjunctiva
R – RAPD, reduced VA, reduction of colour vision (optic neuropathy)
O – Ophthalmoplegia (restricted EOM)
P – Proptosis, pain on EOM
S – Swollen optic disc (compressive optic neuropathy)
S – Swollen, tender, erythematous eyelids (does NOT differentiate preseptal vs orbital)
what are the ocular complications or orbital cellulitis?
- Compressive optic neuropathy, optic neuritis
- Raised IOP
- CRAO, CRVO
- Exposure keratopathy
what are the systemic complications or orbital cellulitis?
- Subperiosteal abscess
- Orbital abscess
- Cavernous sinus thrombosis
- meningitis
what is the management of orbital cellulitis?
- **URGENT admission + URGENT ENT referral for sinus drainage and washout
- IV broad spectrum abx (Augmentin + metronidazole)
- If CT shows subperiosteal abscess 🡪 Sx drainage STAT
- If CT shows no subperiosteal abscess 🡪 close monitoring of vision (visual acuity, IOP, pupillary reaction, etc)
- STAT endoscopic sinus surgery (drain ethmoid sinus to remove source of infection) if:
- -> Refractory to abx, i.e. symptoms do not respond in 24h, or visual acuity worsens
- -> High risk of progression, e.g. immunocompromised
