Periorbital and Orbital Cellulitis

Question 1

What is periorbital cellulitis?

Answer 1

infectious process occurring in eyelid tissues superficial to the orbital septum

Question 2

What is orbital cellulitis?

Answer 2

infectious process affecting muscles and fat within the orbit posterior or deep to orbital septum – no involving globe

Question 3

What is epid of orbital and periorbital cellulitis?

Answer 3

1. Children x2 likely as adults

2. Haemophilus influenza type b (Hib) vaccination decreased incidence

Question 4

What is periorbital cellulitis due to?

Answer 4

superficial tissue injury e.g. insect bite or chalazion

Question 5

What is orbital cellulitis usually due to?

Answer 5

underlying bacterial sinusitis

Question 6

Why can peri-orbital cellulitis be worrying in children?

Answer 6

can be secondary to occult underlying bacterial sinusitis or due to a bacteraemic spread from primary infection – may rapidly progress to orbital cellulitis in children

Question 7

What are RF for periorbital and orbital cellulitis?

Answer 7

1. Childhood esp male
2. Previous sinus infection
3. Lack of Hib vaccination

Question 8

What are the symptoms and signs of periorbital and orbital cellulitis?

Answer 8

1. Recent sinus infection
2. Recent eyelid injury
3. Redness and swelling of eye
4. Ocular pain
5. Decreased vision
6. Proptosis
7. Eyelid oedema
8. Insect bite on eyelid
9. Stye or Chalazion
10. Chemosis

Question 9

What are possible DDx of periorbital and orbital cellulitis?

Answer 9

1. Orbital pseudo-tumour (idiopathic orbital inflammation)
2. Thyroid eye disease
3. Panophtlamitis

Question 10

What are investigations of periorbital and orbital cellulitis?

Answer 10

1. Clinical Examination
2. CT sinus and orbits with contrast medium
3. WBC count

Question 11

What would the CT show?

Answer 11

1. inflammation of peri-orbital or orbital tissue
2. sub-periosteal abscess (commonly superomedial or inferomedial)
3. sinusitis

Question 12

What would WBC count be?

Answer 12

elevated

Question 13

What is the management of periorbital and orbital cellulitis?

Answer 13

antibiotic therapy or antifungal and if appropriate incision, drainage and culture of peri-ocular abscess

Question 14

What are complications of periorbital and orbital cellulitis?

Answer 14

1. Sub-periosteal abscess
2. Cavernous sinus thrombosis
3. Intracranial abscess
4. Subsequent loss of vision or death
5. Meningitis

Question 15

What is the prognosis of peri-orbital cellulitis?

Answer 15

clinical improvement usually seen within 24-48 hours and full resolution