Orbital cellulitis: Difference between revisions
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###Inflammation of ocular muscles | ###Inflammation of ocular muscles | ||
###Subperiosteal or orbital abscess | ###Subperiosteal or orbital abscess | ||
==Differential Diagnosis== | |||
{{Periorbital swelling DDX}} | |||
==Treatment== | |||
===Antibiotics=== | |||
{{Orbital Cellulitis Antibiotics}} | |||
===Consults=== | |||
*Ophthalmology consult to arrange close followup | |||
==Disposition== | |||
*Admit | |||
==Complications== | ==Complications== | ||
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#Epidural abscess | #Epidural abscess | ||
#Brain abscess | #Brain abscess | ||
==See Also== | ==See Also== | ||
Revision as of 17:13, 13 October 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:
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
Treatment
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
See Also
Source
- UpToDate
- Tintinalli