Orbital cellulitis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
[[File:Proptosis 2014-10-28 12-32.jpg|thumb|Orbital [[Cellulitis]]with retrobulbar hematoma and proptosis]] | [[File:Proptosis 2014-10-28 12-32.jpg|thumb|Orbital [[Cellulitis]] with retrobulbar hematoma and proptosis]] | ||
[[File:PMC2892128 MEAJO-17-134-g001.png|thumb|Left orbital cellulitis secondary to penetrating dog bite.]] | |||
*Swelling and erythema of tissues surrounding the orbit AND: | *Swelling and erythema of tissues surrounding the orbit AND: | ||
**Proptosis | **[[Proptosis]] | ||
**Chemosis | **[[red eye|Chemosis]] | ||
**Globe displacement | **Globe displacement | ||
**Limitation of eye movements | **Limitation of EOM | ||
**Double vision | **Pain with eye movements | ||
**Decreased visual acuity | **[[diplopia|Double vision]] | ||
**[[vision loss|Decreased visual acuity]] | |||
**Possible [[third nerve palsy|CN III]], [[trochlear nerve palsy|IV]], [[abducens nerve palsy|VI palsies]] in cases of cavernous sinus involvement | |||
===Complications=== | |||
*Orbital abscess | |||
**Patients 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]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 18: | Line 32: | ||
==Evaluation== | ==Evaluation== | ||
[[File:PMC2892128 MEAJO-17-134-g002.png|thumb|Left medial subperiosteal abscess with associated ethmoid sinusitis.]] | |||
*CT Orbit with IV contrast | *CT Orbit with IV contrast | ||
**Proptosis | |||
**Inflammation of ocular muscles | |||
*Proptosis | **Subperiosteal or orbital abscess | ||
*Inflammation of ocular muscles | |||
*Subperiosteal or orbital abscess | |||
==Management== | ==Management== | ||
===Antibiotics=== | ===Antibiotics=== | ||
{{Orbital Cellulitis Antibiotics}} | {{Orbital Cellulitis Antibiotics}} | ||
*Consider fungal infections with mucor or aspergillus in DM or immunocompromised<ref>Farooq AV et al. Fungal Orbital Cellulitis: Presenting Features, Management and Outcomes at a Referral Center. Orbit. Vol. 34 , Iss. 3,2015.</ref> | *Consider [[fungal infections]] with [[mucormycosis|mucor]] or [[aspergillus]] in DM or immunocompromised<ref>Farooq AV et al. Fungal Orbital Cellulitis: Presenting Features, Management and Outcomes at a Referral Center. Orbit. Vol. 34 , Iss. 3,2015.</ref> | ||
**Amphotericin B IV 0.3 mg/kg/day initially | **[[Amphotericin B]] IV 0.3 mg/kg/day initially | ||
**May require supplemental intra-orbital catheter delivery | **May require supplemental intra-orbital catheter delivery | ||
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==Disposition== | ==Disposition== | ||
*Admit | *Admit | ||
==See Also== | ==See Also== | ||
Latest revision as of 00:11, 27 February 2021
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
Orbital Cellulitis with retrobulbar hematoma and proptosis
- Swelling and erythema of tissues surrounding the orbit AND:
- Proptosis
- Chemosis
- Globe displacement
- Limitation of EOM
- Pain with eye movements
- Double vision
- Decreased visual acuity
- Possible CN III, IV, VI palsies in cases of cavernous sinus involvement
Complications
- Orbital abscess
- Patients 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
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
Evaluation
- CT Orbit with IV contrast
- 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
- Consider fungal infections with mucor or aspergillus in DM or immunocompromised[1]
- Amphotericin B IV 0.3 mg/kg/day initially
- May require supplemental intra-orbital catheter delivery
Consults
- Ophthalmology consult to arrange close follow-up
Disposition
- Admit
See Also
References
- ↑ Farooq AV et al. Fungal Orbital Cellulitis: Presenting Features, Management and Outcomes at a Referral Center. Orbit. Vol. 34 , Iss. 3,2015.