Pre-septal and orbital cellulitis Flashcards
Define cellulitis.
A common bacterial infection of the skin and tissues beneath the skin which presents with redness, swelling and tenderness in the infected area of the skin
Define pre-septal cellulitis.
Infection confined to the orbital soft tissues anterior to the orbital septum and mainly involves the skin of the eyelid and/or the orbicularis oculi muscle
Define orbital cellulitis.
Infection primarily involving the orbital soft tissues posterior to the orbital septum which involves the orbital fat, extraocular muscles and/or neurovascular tissues
Describe the pathophysiology of pre-septal cellulitis.
The pathogenesis of periorbital cellulitis involves bacterial infiltration of the periorbital soft tissues, resulting in inflammation and edema.
The infection remains confined to the structures located anterior to the orbital septum, including the eyelids, subcutaneous tissue, and associated musculature
How is pre-septal cellulitis spread? (3)
- Direct inoculation (most common)
e.g. scratch, insect bite, animal bite - Local spread from adjacent infection
e.g. sinusitis, dacryocystitis - Hematogenous spread from a distant infection
e.g. acute otitis media, pneumonia
Name 4 organisms that can cause pre-septal cellulitis.
- Staphylococcus aureus
- Streptococcus pneumoniae
- Staphylococcus epidermidis
- Streptococcuspyogenes
- Haemophilusinfluenzaetype B
Give 5 risk factors for pre-septal cellulitis.
- Age - <10 years
- Insect bites
- Trauma related lesions
- Lesions caused by a recent surgical procedure near eyelids
- Dacryocystitis
- Hordeola
- Chalaza
- Blepharitis
- Sinusitis/Respiratory tract infections
What are the clinical features for pre-septal cellulitis?
- Unilateral pain, swelling, and redness of the eyelid and periorbital tissues
- Tearing
- Systemic signs of infection, e.g., fever, malaise
- No red flags for orbital cellulitis
Give 4 differential diagnosis for pre-septal cellulitis.
Orbital cellulitis
Conjunctivitis
Blepharitis
Dacryocystitis
Dacryoadenitis
Allergic reaction/angioedema
How is pre-septal cellulitis treated?
1.Empiric oral antibiotics are indicated for all patients
Trimethoprim sulfamethoxazole
Clindamycin
Ceftriaxone
- Surgical drainage for eyelid abscesses
- Ophthalmic consultation and evaluation
Give 4 complications of pre-septal cellulitis.
- Orbital cellulitis
- Subperiosteal abscess
- Orbital abscess
- Cavernous sinus thrombosis
- Orbital cellulitis
- Subperiosteal abscess
- Orbital abscess
- Cavernous sinus thrombosis
What are the 2 types of orbital cellulitis (OC)?
Endogenous (hematogenous spread,e.g. bacteremia) or Exogenous (spread from other regions, e.g. ethmoid sinuses, frontal sinuses, skin etc.)
Describe the pathophysiology of OC.
Orbital cellulitis most commonly occurs in the setting of an upper respiratory or sinus infection. The human upper respiratory tract is normally colonized withS pneumoniae,and infection can occur through several mechanisms.
Infection commonly spreads from adjacent paranasal sinuses through thin lamina papyracea but can also result from other causes to be discussed further.
Leads to inflammation, pus formation and potential compression of optic nerve.
Give 4 risk factors for OC.
Male Gender
Sinus disease, e.g. ethmoid sinusitis, maxillary sinusitis
Infection of other adjacent structures, e.g. pre-septal or facial infections, dacrocystitis, dental abscess.
Trauma; insect bites
Surgical: Orbital, lacrimal, vitreoretinal surgery
Immunodeficiency
What are the groups in Chandler’s classification?
Group I: Inflammatory edema (preseptal cellulitis) - infection confined to the eyelid, anterior to the orbital septum.
Group II: Orbital cellulitis - infection involving the orbit and post-septal tissues.
Group III: Subperiosteal abscess - accumulation of pus beneath the periosteum of the orbit.
Group IV: Orbital abscess - a collection of pus within the orbit itself.
Group V: Cavernous sinus thrombosis - a serious complication involving clot formation in the cavernous sinus.
Give 6 signs and symptoms of OC.
Acute Fever
Painful headache
Malaise
Eyelid swelling and redness
Double Vision/ Decreased vision
Erythematous lids (swollen, tender, red, warm)
Proptosis
Painful restricted eye movement
Chemosis
Painful ophthalmoplegia (on eye movement exam)
Mention 4 differential diagnosis for OC.
- Pres-septal cellulitis
- Langerhans cell histiocytosis
- Pediatric mucormycosis
- Retrobulbar haemorrhage
- Thyroid ophthalmopathy
- Retinoblastoma
- Adenoviral conjunctivitis
What investigations should be done for OC?
CT scan, MRI, Culture
How is OC treated?
- Broad-spectrum intravenous antibiotics
- Intravenous corticosteroids may also be of benefit in the management of pediatric orbital cellulitis
- Drainage of an orbital abscess should be considered at an early stage
- Severe optic nerve compression may warrant an emergency canthotomy/cantholysis
Give 5 complications for OC.
- Subperiosteal abscess
- Orbital abscess
- Cavernous sinus thrombosis
- Meningitis
- Severeexposure keratopathywith secondary ulcerative keratitis
- Neurotrophic keratitis
- Secondary glaucoma
- Exudative retinal detachment
