Orbital Cellulitis (post-septal)

Question 1

Background

Answer 1

Ocular emergency requiring immediate medical attention.

Normally is secondary to infection from the ethmoid sinuses, eye surgery, dacryocystitis, stye or chalazions
Causative organism:
Children = Haemophilus influenza.
- can spread causing meningitis.
Adults = Staphylococcus aureus and/or Streptococci.

Question 2

Signs and symptoms/ Assessment/ Diagnosis

Answer 2

• Eye movement becomes limited and painful
• Mild fever
• Tightness of the eyelid skin,
• Bogginess of conjunctiva,
• reddeining of the eyelid,
• Oedema and
• Tenderness

Assessment & Diagnosis:
- Ophthalmic Examination - socrates, visual etc
- Hx
- CT scan of orbits and sinuses
- Cultures

Question 3

Treatment

Answer 3

Sinus drainage may be needed.
IV antibiotics followed by oral course.
Usually referred to specialist.

Adults no referral required (eyes or nose):
1st line - Co-amoxiclav 500/125mg TDS - 7 days
ALT - Clarithromycin 500mg BD - 5–7 days + metronidazole 400mg TDS for 7 days

Child no referral required (eyes or nose):
1st line - Co-amoxiclav TDS for 7 days
ALT Clarithromycin BD for 7 days
OR
Clarithromycin + metronidazole BD for 7 days if the presence of anaerobes is SUS (1 month 7.5mg/kg BD;
2 months - 11 years, 7.5 mg/kg TDS [MAX/dose 400mg];
12–17 years, 400mg TDS).

REVIEW after 2-3 days or if local symptoms get worse.
ORAL - after 7 days no improve check adherence or try ALT
after 14 days or worse symptoms exclude differential, consider specialist.