Orbital Cellulitis Flashcards
Define orbital cellulitis
Infection within the orbital soft tissues with associated dysfunction and is usually due to underlying bacterial sinusitis
Define peri-orbital cellulitis
Inflammation and infection of the superficial eyelid, usually from a superficial source. Inflammation remains confined to the soft tissue layers superficial to the orbital septum and ocular function remains
What is the aetiology of Periorbital & orbital cellulitis
Pathogens: Staph. aureus, Staph. epidermidis, Streptococcus species, anaerobes
Source:
Paranasal sinus infection
Dental abscess
Orbital injury
Fracture
Dacrocystitis
Endophthalmitis
Haematogenous spread
DKA or immunosuppression → fungal infection (mucormycosis or invasive aspergillosis)
What are the risk factors for Periorbital & orbital cellulitis
Male children
Previous sinus infection (sinusitis)
Lack of Hib vaccination
Skin infection
Recent dental infection or dental work
Orbital fracture
Foreign body in eye/orbit
(The bony orbit is thin, and is penetrated by many small nerves, vessels, and minute defects (Zuckerkandl dehiscences). This predisposes the area to the spread of infection from adjacent sinuses. Septic thrombophlebitis affecting the valveless veins that bridge the orbit and the sinuses also facilitate the spread of infection. There are no lymphatics in the orbit to serve as a carrier of infection)
What are the symptoms and signs of Periorbital cellulitis
Fever
Erythema, tenderness and swelling of the eyelid or other skin adjacent to the eyes
- Almost always unilateral
-May follow local trauma to the skin
Ocular pain
Recent sinus infection
Stye or chalazion on the eyelid
Ptosis
What are the symptoms and signs of orbital cellulitis
Painful or limited ocular movement
± reduced visual acuity or loss of vision (11%)
Diplopia
Proptosis
Headache, Malaise
Recent sinus infection
What investigations should be done for Periorbital & orbital cellulitis
Bedside: complete ophthalmological examination (visual acuity + RAPD), NPA/conjunctival swab for microbiology (+ve)
Bloods: FBC, blood culture
Other:
- CT/MRI sinus and orbits + contrast: Inflammation of peri-orbital or orbital tissue; sub-periosteal abscess (commonly superomedial or inferomedial); sinusitis
What is the management for peri-orbital cellulitis
Mild: outpatient treatment with empirical oral antibiotic therapy e.g. co-amoxiclav + clindamycin
Moderate-severe: Admit
IV Abx: high-dose ceftriaxone (prevents posterior spread → orbital cellulitis) for 2-5 days
What is the management for peri-orbital cellulitis with abscess
Abscess <1cmx0.4cm AND no visual compromise → medical management
Abscess → surgical drainage
What are the complications of Periorbital & orbital cellulitis
Abscess formation (sub-periosteal, orbital, epidural)
Ocular empyema
Meningitis
Cavernous sinus thrombosis (papilloedema, neuro signs, visual loss, muscle paresis)
Ocular compartment syndrome
What is the prognosis for Periorbital & orbital cellulitis
Pre-orbital:
- Excellent prognosis
- Clinical improvement seen within 24-48 hours
Orbital:
- Lag time of 24-48h between imitation of antibiotics and clinical response
- Prompt and proper antibiotic treatment and drainage of sinusitis is critical to avoid progression to sub-periosteal orbital abscess, epidural abscess, and meningitis.
What is the difference between pre and post septal cellulitis
Pre-septal: infection from the conjunctive or eyelids
post-septal: infection from the frontal or ethmoid sinuses
Management for orbital cellulitis
Admit and refer to ophthalmology
Empirical IV abx: IV cefuroxime
± empirical antifungal therapy (amphotericin B deoxycholate)
± nasal decongestant
± Lateral canthotomy and cantholysis may be required to reduce intra-ocular pressure before orbitotomy can be performed if there is visual loss at presentation
± orbitotomy and surgical drainage of orbital abscess
