Periorbital/Preseptal and orbital cellulitis Flashcards
Periorbital refers to tissues infront of the septum. Orbital cellulitis refers to tissues behind the orbital septum. Cellulitis refers to an infection. Which of the following is NOT involved in preseptal cellulitis?
1 - eyelids
2 - muscles of the eye
3 - skin
4 - subcutaneous tissue of the face
2 - muscles of the eye
In all suspected cases of preseptal or orbital cellulitis, which of the following should always be asked in the history?
1 - recent sinusitis
2 - insect bites
3 - infected lid lesions
4 - history of trauma
5 - all of the above
5 - all of the above
What is the incidence of preseptal cellulitis?
1 - 1 cases per 100,000
2 - 10 cases per 100,000
3 - 100 cases per 100,000
4 - 1000 cases per 100,000
2 - 10 cases per 100,000
Equally as common in males and females
What age does the incidence of preseptal cellulitis peak at?
1 - 6-15 years
2 - 20-35 years
3 - 40-60 years
4 - >65 years
1 - 6-15 years
Is preseptal or orbital cellulitis more serious?
- orbital cellulitis
Orbit has no lymph nodes, so no immune system
Offers a direct passage through to the brain
Preseptal cellulitis typically is caused by an break in the skin, sinusitis, or respiratory tract infection that spreads to the structures surrounding the orbit. All of the following organisms can causes this, but which is the most common cause?
1 - Staphylococcus aureus
2 - Staphylococcus epidermidis
3 - streptococci
4 - anaerobic bacteria
1 - Staphylococcus aureus
Patients typically present with all of the following in preseptal cellulitis, EXCEPT which one?
1 - acute onset of pain
2 - pain upon moving the eye
3 - red eye
4 - swollen eye
5 - fever like symptoms
2 - pain upon moving the eye
Common in orbital cellulitis, but not preseptal cellulitis
Can ptosis (drooping of the eyelid) occur in preseptal cellulitis?
- yes
Can be complete or partial depending on the swelling of the eyelids
Which of the following diagnostic tests would NOT typically be performed in preseptal cellulitis?
1 - blood inflammatory markers
2 - swab of eye
3 - blood cultures
4 - CT with contrast of eye
5 - clinical examination
4 - CT with contrast of eye
ALWAYS performed in orbital cellulitis, but not preseptal cellulitis
All of the following are likely differentials for preseptal cellulitis, but which is most likely?
1 - allergic reaction
2 - orbital cellulitis
3 - trauma
4 - thyroid eye disease
2 - orbital cellulitis
Do patients with preseptal cellulitis always need to be referred to secondary care?
- yes
Important to rule out orbital cellulitis
In preseptal cellulitis, how are patients treated typically?
1 - topical antibiotics
2 - debridement and washout
3 - oral antibiotics
4 - wait and see
3 - oral antibiotics
Typically amoxicillin
What is the most concerning complication of preseptal cellulitis?
1 - scarring
2 - rhinitis
3 - orbital cellulitis
4 - conjunctivitis
3 - orbital cellulitis
What is the incidence of orbital cellulitis?
1 - 1 cases per 100,000
2 - 10 cases per 100,000
3 - 100 cases per 100,000
4 - 1000 cases per 100,000
1 - 1 cases per 100,000
What age does the incidence of orbital cellulitis peak at?
1 - 6-15 years
2 - 20-35 years
3 - 40-60 years
4 - >65 years
1 - 6-15 years
Which of the following is NOT a risk factor for developing orbital cellulitis?
1 - old age
2 - previous sinus infection
3 - no haemophilus influenzae type b (Hib) vaccination
4 - recent eyelid infection/ insect bite on eyelid (Peri-orbital cellulitis)
5 - ear or facial infection
1 - old age
Orbital and preseptal cellulitis is more common in children 6-15 years old
Patients can present with all of the following in orbital cellulitis, EXCEPT which one?
1 - severe ocular pain
2 - no pain upon moving the eye
3 - red and swelling around the eye
4 - swollen eye with exophthalmos
5 - fever like symptoms
6 - visual disturbance
7 - meningeal involvement (Rare)
2 - no pain upon moving the eye
There is extreme pain when moving the eye
In orbital cellulitis, can complete ophthalmoplegia (inability to move eye in any direction) occur?
- yes
Can also lead to optic nerve compression
Can ptosis (drooping of the eyelid) occur in orbital cellulitis?
- yes
Can be complete or partial depending on the swelling of the eyelids
All of the following diagnostic tests can be performed in orbital cellulitis, but which one MUST be performed in orbital cellulitis is suspected?
1 - blood inflammatory markers
2 - swab of eye
3 - blood cultures
4 - CT with contrast of eye
5 - clinical examination
4 - CT with contrast of eye
Also good for ruling out a periorbital abscess
Which of the following are likely differentials for orbital cellulitis?
1 - allergic reaction
2 - preseptal cellulitis
3 - trauma
4 - thyroid eye disease
5 - periorbital abscess
5 - all of the above
5 - all of the above
Do patients with orbital cellulitis always need to be referred to secondary care?
- yes
Can be very dangerous
In orbital cellulitis, how are patients treated typically?
1 - topical antibiotics
2 - IV antibiotics and hospital admission
3 - oral antibiotics
4 - wait and see
2 - IV antibiotics and hospital admission
These would be broad spectrum antibiotics
Which 2 of the following are the most dangerous complications that can occur if the infection causing orbital cellulitis begins tracking to the brain?
1 - occlusion of lacrimal vein
2 - cavernous sinus thrombosis
3 - encephalitis
4 - ocular nerve palsy
2 - cavernous sinus thrombosis
3 - encephalitis
- inflammation of the brain
