Preseptal/Orbital Cellulitis Flashcards
What is preseptal cellulitis?
Infection of soft tissues anterior to the orbital septum:
Eyelids, skin and SC tissue fo face but not the contents of the orbit
What is orbital cellulitis
Infection of the soft tissues behind the orbital septum - fat and muscles but not involving the globe
What organisms cause preseptal cellulitis?
Staphylococcus aureus
Stpahyloccocus epidermis
Streptococci
Anaerobes
Spread from respiratory tract infections, sinusitis
What are symptoms of preseptal cellulitis?
Red, swollen, painful eye of acute onset
Fever
What are signs of pre-septal cellulitis?
Erythema and oedema of eyelids
Partial or complete ptosis due to swelling
Orbital signs absent!
What are differentials?
Pre-septal cellulitis
Orbital cellulitis
Allergic reaction
Nephrotic syndrome
Ix?
Bloods: FBC, CRP, ESR, BC
Swab of any discharge
Contrast CT of orbit may help to differentiate between preseptal and orbital cellulitis
What is Mx of preseptal cellulitis?
Refer to hospital
Oral/IV co-amoxiclav/flucloxacillin
What are risk factors for orbital cellulitis?
Childhood Previous sinusitis Lack of haemophilus influenzae b vaccination REcent eyelid infection Ear/facial infection
What are CF of orbital cellulitis
Redness and swelling around the eye Severe ocular pain Visual disturbance Proptosis Ophthalmoplegia/pain with eye movement Eyelid oedema and ptosis
Differentiating orbital cellulitis and presetpal cellulitis?
Reduced visual acuity, proptosis, ophthalmoplegia/pain with eye movements are NOT consistent with preseptal cellulitis
Ix in orbital cellulitis
FBC
CRP
ESR
Blood culture
Ophthalmological assessment: Decreased vision RAPD Proptosis Oedema
CT with contrast - inflammation or orbital tissue deep to orbital septum
Swab eye
What is the orbital septum
Membranous sheet that acts as the anterior boundary of the orbit. It extends from the orbital rims to the eyelids. It forms the fibrous portion of the eyelids.
Mx of orbital cellulitis
Admission
IV cefotaxime
