Orbital cellulitis

Background

• Must distinguish between periorbital and orbital cellulitis
  • See Orbital vs Periorbital 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

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

Treatment

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

• Ophthalmology consult to arrange close followup

Disposition

• Admit

See Also

• Periorbital vs Orbital Cellulitis
• Periorbital Swelling
• Periorbital Cellulitis

Source

• UpToDate
• Tintinalli