Orbital cellulitis: Difference between revisions
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===Background===
===Background===
*Must distinguish between periorbital and orbital cellulitis!
*Must distinguish between periorbital and orbital cellulitis
**See [[Orbital vs Periorbital Cellulitis]]
**See [[Orbital vs Periorbital Cellulitis]]
*Orbital cellulitis may mimic periorbital cellulitis early in its course  
*Orbital cellulitis may mimic periorbital cellulitis early in its course  
*Orbital cellulitis most often 2/2 ethmoid sinusitis
*Orbital cellulitis most often due to ethmoid sinusitis
**May also be 2/2 orbital trauma, endophthalmitis, infectious infection from teeth / middle ear
**May also be due to trauma, endophthalmitis, infection from teeth/middle ear, FB


==Diagnosis==
==Clinical Features==
===Signs/Symptoms===
#Proptosis
#All of the above plus:
#Chemosis
##Proptosis
#Globe displacement
##Chemosis (conj. swelling)
#Limitation of eye movements
##Globe displacement
#Double vision
##Limitation of eye movements
#Decreased visual acuity
##Double vision
##Vision loss (indicates orbital apex involvement)


===Imaging===
===Imaging===
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==Complications==
==Complications==
# Orbital Abscess
#Orbital Abscess
## Pts tend to have severe proptosis, globe displacement, and appear systemically ill
## Pts tend to have severe proptosis, globe displacement, and appear systemically ill
## May be clinically indistinguishable from orbital cellulitis; requires CT  
##May be clinically indistinguishable from orbital cellulitis; requires CT  
# Meningitis
#Meningitis
# Cavernous sinus thrombosis  
#Cavernous sinus thrombosis
#Frontal bone osteomyelitis
#Subdural empyema
#Epidural abscess
#Brain abscess


==Treatment==
==Treatment==
# Vancomycin +
#Vancomycin +
## Ampicillin-sulbactam 3 g IV q6hr OR
##Ampicillin-sulbactam 3 g IV q6hr OR
## 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


==Disposition==
==Disposition==

Revision as of 01:37, 25 October 2011

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. Proptosis
  2. Chemosis
  3. Globe displacement
  4. Limitation of eye movements
  5. Double vision
  6. Decreased visual acuity

Imaging

  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

  1. Vancomycin +
    1. Ampicillin-sulbactam 3 g IV q6hr OR
    2. Ticarcillin-clavulanate 3.1 g IV q4h OR
    3. Piperacillin-tazobactam 4.5 g IV q6h OR
    4. Ceftriaxone 2 g IV q12hr OR
    5. Cefotaxime 2 g IV q4h
  2. Ophthalmology consult

Disposition

  • Admit

See Also

Source

UpToDate

Tintinalli

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