Orbital cellulitis

From WikEM
Jump to: navigation, search

Background

Periorbital vs orbital cellulitis

  • Orbital cellulitis may mimic periorbital cellulitis early in its course
  • Orbital cellulitis
    • Ocular emergency
    • Most often due to ethmoid sinusitis
    • May also be due to orbital trauma, endophthalmitis, infection from teeth / middle ear
    • Not caused by extension of periorbital cellulitis
  • Periorbital cellulitis
    • Usually benign
    • Most often due to contiguous infection of soft tissues of face and eyelids

Clinical Features

Orbital Cellulitiswith retrobulbar hematoma and proptosis
  • Swelling and erythema of tissues surrounding the orbit AND:
    • Proptosis
    • Chemosis
    • Globe displacement
    • Limitation of eye movements secondary to pain and inflammation.
    • Double vision
    • Decreased visual acuity

Differential Diagnosis

Periorbital swelling

Proptosis

No proptosis

Lid Complications

Other

Evaluation

  • CT Orbit with IV contrast

Findings consistent with orbital cellulitis

  • Proptosis
  • Inflammation of ocular muscles
  • Subperiosteal or orbital abscess

Management

Antibiotics

Vancomycin 15-20mg/kg IV BID + (one of the following)

Consults

  • Ophthalmology consult to arrange close follow-up

Disposition

  • Admit

Complications

  • Orbital abscess
    • Patients tend to have severe proptosis, globe displacement, and appear systemically ill
    • May be clinically indistinguishable from orbital cellulitis; requires CT
  • Meningitis
  • Cavernous sinus thrombosis
  • Frontal bone osteomyelitis
  • Subdural empyema
  • Epidural abscess
  • Brain abscess

See Also

References

  1. Farooq AV et al. Fungal Orbital Cellulitis: Presenting Features, Management and Outcomes at a Referral Center. Orbit. Vol. 34 , Iss. 3,2015.