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Updated: Dec 15 2021

Orbital Cellulitis

  • 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.
  • Overview
    • Infection involving the fat and ocular muscles in the orbit
      • the globe of the eye is not involved
  • Introduction
    • 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
  • 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
  • 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
  • Prognosis
    • Good with prompt antibiotic administration
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