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Snapshot
  • A 12-year-old boy presents to the emergency department with right eye pain. His eye pain is associated with eyelid swelling and pain with eye movements. He previously had a bacterial rhinosinusitis. Physical examination is notable for a swollen eyelid with impaired extraocular movements. Blood cultures are obtained and he is admitted to the hospital for intravenous antibiotic administration.
Introduction
  • Overview
    • infection involving the fat and ocular muscles in the orbit
      • the globe of the eye is not involved
  • Epidemiology
    • demographics
      • more common in young children
    • risk factors
      • bacterial rhinosinusitis (most common cause)
        • ethmoid sinusitis
        • pansinusitis
      • ophthalmic surgery
      • infection of the teeth, middle ear, or face
      • orbital tauma
  • Microbiology
    • Staphylococcus aureus and streptococci (most common)
    • Mucorales
      • leads to mucormycosis
    • Aspergillus spp.
  • Pathophysiology
    • microorganisms spread from the sinuses into the orbital cavity
    • hematogenous spread via the valveless venous system that drains the eye cavity and maxillarry and ethmoid sinuses
    • orbital trauma leads to direct inoculation of the microorganisms
    • all 3 of these mechanisms lead to an inflammatory response
      • results in mechanical compression of the ocular arteries and muscles
  • Prognosis
    • good with prompt antibiotic administration
Presentation
  •  Symptoms 
    • ocular pain
      • also with eye movements
  • Physical exam   
    • opthalmoplegia
      • can lead to diplopia
    • eyelid swelling
    • proptosis
    • decreased visual acuity
Imaging
  • CT scan
    • imaging studies of choice
Studies
  • Blood cultures
    • obtain prior to antibiotic treatment
Differential
  • Preseptal cellulitis
    • differentiating factors
      • no pain with eye movements
      • no ophthalmoplegia
      • no visual impairment
Treatment
  • Medical
    • antibiotic therapy
      • indication
        • all cases of orbital cellulitis
      • medications
        • vancomycin and ceftriaxone
        • vancomycin and cefotaxime
  • Surgical
    • surgical intervention
      • indication
        • intracranial complications
        • retinal and optic nerve compression
Complications
  • Blindness
  • Abscess formation
    • subperiosteal
    • orbtical
  • Cavernous sinus thrombophlebitis
  • Brain abscess

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