Orbital cellulitis: Difference between revisions
Line 38: | Line 38: | ||
##Ticarcillin-clavulanate 3.1 g IV q4h OR | ##Ticarcillin-clavulanate 3.1 g IV q4h OR | ||
##Piperacillin-tazobactam 4.5 g IV q6h OR | ##Piperacillin-tazobactam 4.5 g IV q6h OR | ||
##Ceftriaxone 2 g IV q12hr OR | ##[[Ceftriaxone]] 2 g IV q12hr OR | ||
##Cefotaxime 2 g IV q4h | ##Cefotaxime 2 g IV q4h | ||
#Ophthalmology consult | #Ophthalmology consult |
Revision as of 05:40, 27 February 2014
Background
- Must distinguish between periorbital and orbital cellulitis
- Orbital cellulitis may mimic Periorbital Cellulitis early in its course
- Orbital cellulitis most often due to ethmoid sinusitis
- May also be due to trauma, endophthalmitis, infection from teeth/middle ear, FB
Clinical Features
- Swelling and erythema of tissues surrounding the orbit AND:
- Proptosis
- Chemosis
- Globe displacement
- Limitation of eye movements
- Double vision
- Decreased visual acuity
Diagnosis
- CT Orbit with IV contrast
- Findings c/w orbital cellulitis:
- Proptosis
- Inflammation of ocular muscles
- Subperiosteal or orbital abscess
- Findings c/w orbital cellulitis:
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
Treatment
- Vancomycin +
- 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
- Ophthalmology consult
Disposition
- Admit
See Also
Source
- UpToDate
- Tintinalli