Periorbital and orbital cellulitis Flashcards
What is peri-orbital cellulitis?
pre-septal cellulitis
Infection of soft tissues around but no including the orbit
Pyrexia
What is orbital cellulitis?
Inflammation/infection of the soft tissue surrounding the eye and post-septal structures
Such as CN2,3,4,6
Post-septal structures
What is the key epidemiology of (peri-)orbital cellulitis?
Peri - age 5
Orbital - age 7yrs
Orbital boys more likely to be affected
What is the most common aetiology of (peri)orbital cellulitis?
Bacteria on skin - skin breach or nearby infection in sinuses
Complication from ophthalmic surgery
What are the most common causes of (peri)orbital cellulitis?
Haemophilus influenxa type B
Streptococcus pneumoniae
Staphylococcus aureus
Gonorrhoes and chlamydia in neonates
What are the key signs of peri-orbital cellulitis?
Erythema
swelling
pain
System fever and malsise
Lympahdenopathy
What red flags seperate orbital from peri-orbital cellulitis?
Limited or painful eye movements
Vision changes
Proptosis
Focal neurological signs - photophobia or signs of IC involvement
What are the key investigations for orbital cellulitis?
Bacterial swab from eye, throat and nose
FBC, blood cultures
Contrast CT orbits, sinuses +/- brain to look for spread/complication
What investigation is contraindicated in orbital cellulitis?
Lumbar puncture due to risk of raised ICP with intracranial spread
What are the features of mild periorbital cellulitis?
Normal vision
Apyrexia
Mild swellbing
What is the treatment for mild peri-orbital cellulitis?
No referral
Oral antibiotics
Underlying cause - intranasal corticosteroids
What is the treatment for sever peri-orbital or orbital cellulitis?
Refer to opthalmologist urgently
Antibiotics - IV for orbital
Paracetamol for fever and analgesia
What are some complication of peri-orbital cellulitis?
Orbital cellulitis
lagophthalmas (inability to close the eye)
Lif necrosis
Norm no complication good recovery within 1 week.
What are some complications of orbital cellulitis?
Permanent vision loss
Intracranial spread
Cavernous sinus thrombosis
Fulminant sepsis
Exposure keratopathy
optic neuropathy
