Orbital cellulitis

Question 1

What are the pathogenic causes of orbital cellulitis?

Answer 1

Staph. aureus and strep. pneumoniae are most common causes
Haemophilus influenza
Beta-haemolytic streptococcus
Fungal e.g. aspergillus in immunocompromised

Question 2

What risk factors can increase the risk of developing orbital cellulitis?

Answer 2

Previous sinusitis
Previous ear or facial infection
Recent preseptal cellulitis
Lack of Haemophilus influenzae vaccination
Childhood

Question 3

What are the features of orbital cellulitis?

Answer 3

Redness and swelling around eye
Ptosis and red/purple eyelids
Proptosis
Severe ocular pain
Opthalmoplegia/pain with eye movements
Visual disturbances (reduced VA and diplopia)
RAPD
Fever, malaise

Question 4

How can you differentiate orbital from preseptal cellulitis?

Answer 4

The reduced VA, proptosis, ophthalmoplegia/pain with eye movements, RAPD are NOT found in preseptal cellulitis

Question 5

What investigations should be carried out to help diagnose orbital cellulitis?

Answer 5

Eye examination:
Reduced VA
RAPD
Proptosis
Dysmotility
Oedema
Erythema

FBC:
Raised WBC
Raised inflammatory markers

CT head with contrast:
Inflammation of the orbital tissues deep to the septum
Sinusitis

Blood culture and microbiological swab

Question 6

What is the treatment for orbital cellulitis?

Answer 6

IV abx e.g. co-amoxiclav

Question 7

What is the treatment for preseptal cellulitis?

Answer 7

Oral abx - co-amoxiclav