Orbital cellulitis: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
*CT Orbit with IV contrast | *CT Orbit with IV contrast | ||
===Findings consistent with orbital cellulitis=== | |||
*Proptosis | |||
*Inflammation of ocular muscles | |||
*Subperiosteal or orbital abscess | |||
==Management== | ==Management== | ||
Revision as of 09:41, 3 June 2015
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
- Swelling and erythema of tissues surrounding the orbit AND:
- Proptosis
- Chemosis
- Globe displacement
- Limitation of eye movements
- Double vision
- Decreased visual acuity
Differential Diagnosis
Periorbital swelling
Proptosis
- Normal IOP
- Orbital cellulitis
- Orbital pseudotumor
- Orbital tumor
- Increased IOP
- Retrobulbar abscess
- Retrobulbar emphysema
- Retrobulbar hemorrhage
- Ocular compartment syndrome
- Orbital tumor
No proptosis
- Periorbital cellulitis/erysipelas
- Dacryocystitis (lacrimal duct)
- Dacryocele/Dacryocystocele
- Dacryostenosis
- Dacryoadenitis (lacrimal gland)
- Allergic reaction
- Nephrotic Syndrome (pediatrics)
Lid Complications
- Blepharitis (crusts)
- Chalazion (meibomian gland)
- Stye (hordeolum) (eyelash folicle)
Other
- Subperiosteal abscess
- Orbital abscess
- Cavernous sinus thrombosis
- Conjunctivitis
- Contact dermatitis
- Herpes zoster
- Herpes simplex
- Sarcoidosis
- Granulomatosis with polyangiitis
Diagnosis
- 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)
- Ampicillin/Sulbactam 3 g IV q6hr OR
- Ticarcillin/Clavulanate 3.1 g IV q4h OR
- Piperacillin-Tazobactam 4.5 g IV q6h OR
- Ceftriaxone 2 g IV q12hr OR
- Cefotaxime 2 g IV q4h
Consults
- Ophthalmology consult to arrange close followup
Disposition
- Admit
Complications
- Orbital Abscess
- Pts 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