Orbital Cellulitis

Question 1

orbital cellulitis

Answer 1

bacterial or fungal infection of soft tissues posterior to the orbital septum: fat, connective tissue, muscle

Question 2

orbital cellulitis etiology/associations

Answer 2

• extension from and adjacent infection (sinusitis, hordeolum, dacryoadenitis, dacryocystitis, dental infection)
• post-operative eyelid, orbital, paranasal sinus surgery
• ocular trauma (e.g., orbital fracture, penetrating orbital injury)
• vascular extension from septic cavernous sinus thrombosis or bacteremia
• most commonly Staphylococcus, Streptococcus, Haemophilus influenzae
• less commonly Aspergillus, Mucormycetes (infections caused by this fungus are called mucormycosis)

Question 3

orbital cellulitis demographics

Answer 3

• depends on etiology

- however, more common in children

Question 4

orbital cellulitis laterality

Answer 4

unilateral

Question 5

orbital cellulitis symptoms

Answer 5

• eyelid swelling, redness, and tenderness/pain, heat
• red eye
• bulging/displaced eye
• double vision
• pain on eye movement
• fever
• if fungal, black mucous discharge from nose and eyes

Question 6

orbital cellulitis signs

Answer 6

• eyelid edema, erythema, and tenderness/pain
• conjunctival chemosis and injection
• proptosis
• globe displacement
• restricted EOM and pain with eye movement
• fever
• if fungal, necrotic eschars

Question 7

orbital cellulitis complications

Answer 7

• compression on the globe and/or optic nerve
• orbital abscess
• cavernous sinus thrombosis
• meningitis

Question 8

orbital cellulitis management

Answer 8

• refer to ED
• orbital CT or MRI: look for source of infection (e.g., sinusitis) and rule out other processes such as an orbital abscess or tumor
• IV antibiotic or antifungal

Question 9

orbital cellulitis pearls:

• one of the few _____ that needs _____
• infection can progress _____ in severe cases with potential _____
• ____ is the most common cause of orbital cellulitis
• fungal infections are rare and typically occur in _____

Answer 9

ophthalmic emergencies;
prompt recognition and treatment;
rapidly over a few hours; 
life-threatening complications;
extension of sinusitis;
immunocompromised patients