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 2/2 ethmoid sinusitis
  • May also be 2/2 orbital trauma, endophthalmitis, infectious infection from teeth / middle ear

Diagnosis

Signs/Symptoms

1. All of the above plus:
   1. Proptosis
   2. Chemosis (conj. swelling)
   3. Globe displacement
   4. Limitation of eye movements
   5. Double vision
   6. Vision loss (indicates orbital apex involvement)

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

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

Disposition

• Admit

See Also

• Periorbital vs Orbital Cellulitis
• Periorbital Swelling
• Periorbital Cellulitis

Source

UpToDate

Tintinalli