Periorbital & Orbital Cellulitis Flashcards
What does orbital cellulitis involve?
Infection of the muscle and fat within the orbit, posterior to the orbital septum
In which population is orbital cellulitis most common?
Children
What is a serious consequence of orbital cellulitis?
Sight-threatening condition
What are the common causes of orbital cellulitis?
- Local spreading infection from acute bacterial sinusitis
- Extension of peri-orbital cellulitis
- Haematogenous spread
- Orbital trauma (e.g. dog bite)
- Contiguous spread from face or teeth
Which organisms are most commonly associated with orbital cellulitis?
- Staphylococcus
- Streptomyces
- Haemophilus
What are common symptoms of orbital cellulitis?
- Erythema and swelling around eye
- Blurred vision
- Painful eye movements
- Change in colour vision
- Fever
What are some examination findings for orbital cellulitis?
- Severe erythema and swelling
- Fever
- Painful eye movements
- Reduced visual acuity and/or visual fields
- Proptosis
- Relevant afferent pupillary defect - Marcus-Gunn pupil
- Chemosis
- Altered colour vision
What might bilateral eye signs indicate in orbital cellulitis?
Cavernous sinus thrombosis (severe disease)
What are some red flag symptoms indicating severe disease?
- Nausea
- Vomiting
- Headache
- Neck stiffness
What imaging is required for assessing orbital cellulitis?
Contrast-enhanced CT of orbit, sinuses, brain
What are the indications for imaging in orbital cellulitis?
- Eye examination not possible
- Red flag features
- Failure to improve after 36-48 hours of antibiotics
What is the first step in the management of orbital cellulitis?
Emergency referral to ophthalmology
What is the typical duration of IV antibiotics for orbital cellulitis?
7-10 days
When is surgical management indicated in orbital cellulitis?
If orbital collection is present on imaging
What is Chandler’s classification?
Anatomical classification of orbital complications of acute rhinosinusitis
What are some complications of orbital cellulitis?
- Cavernous sinus thrombosis
- Loss of vision
- Intracerebral abscess
- Meningitis
What does peri-orbital cellulitis involve?
Infection in eyelid tissues anterior to orbital septum
How does peri-orbital cellulitis compare to orbital cellulitis in terms of severity?
Much more common and less serious
What are common causes of peri-orbital cellulitis?
- Superficial injury (e.g. insect bite, chalazion)
- Secondary to upper respiratory tract infection or sinusitis
What are common symptoms of peri-orbital cellulitis?
- Pain
- Redness
- Swelling of eyelid
What is the management approach for paediatric patients with peri-orbital cellulitis?
Urgent referral for IV antibiotics
What is the management approach for adults with peri-orbital cellulitis?
Oral co-amoxiclav
