Orbital cellulitis

Revision as of 17:13, 13 October 2014 by Rossdonaldson1 (talk | contribs)

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

  1. Swelling and erythema of tissues surrounding the orbit AND:
    1. Proptosis
    2. Chemosis
    3. Globe displacement
    4. Limitation of eye movements
    5. Double vision
    6. Decreased visual acuity

Diagnosis

  1. CT Orbit with IV contrast
    1. Findings c/w orbital cellulitis:
      1. Proptosis
      2. Inflammation of ocular muscles
      3. Subperiosteal or orbital abscess

Differential Diagnosis

Periorbital swelling

Proptosis

No proptosis

Lid Complications

Other

Treatment

Antibiotics

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

Consults

  • Ophthalmology consult to arrange close followup

Disposition

  • Admit

Complications

  1. Orbital Abscess
    1. Pts tend to have severe proptosis, globe displacement, and appear systemically ill
    2. May be clinically indistinguishable from orbital cellulitis; requires CT
  2. Meningitis
  3. Cavernous sinus thrombosis
  4. Frontal bone osteomyelitis
  5. Subdural empyema
  6. Epidural abscess
  7. Brain abscess

See Also

Source

  • UpToDate
  • Tintinalli