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Review Question - QID 210526

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QID 210526 (Type "210526" in App Search)
A 27-year-old woman presents to the emergency department with eye pain for the past 2 days with discharge from the eye. The patient has a medical history of type I diabetes and is currently taking insulin. Her temperature is 102°F (38.9°C), blood pressure is 127/68 mmHg, pulse is 100/min, respirations are 17/min, and oxygen saturation is 98% on room air. A physical exam is notable for the finding in Figure A. Examination of cranial nerve III elicits pain. Which of the following is the most likely diagnosis?
  • A

Infection anterior to the orbital septum

30%

13/44

Infection posterior to the orbital septum

64%

28/44

Maxillary osteomyelitis

0%

0/44

Meibomian gland infection

2%

1/44

Thrombus within the cavernous sinus

5%

2/44

  • A

Select Answer to see Preferred Response

This patient is presenting with erythema and edema of the orbit with pain with extraocular movements suggesting a diagnosis of orbital cellulitis (infection posterior to the orbital septum).

Orbital cellulitis presents similar to periorbital cellulitis with inflammation, erythema, and edema of the eye. Key differentiating factors between these 2 pathologies are that orbital cellulitis presents with impairment of cranial III, pain with extraocular movements, proptosis, and vision impairment, whereas periorbital cellulitis does not. The extent of the infection should be assessed with a CT scan of the head with contrast and IV antibiotics should be started.

Tsirouki et al. review the evidence regarding the diagnosis and treatment of orbital cellulitis. They discuss how this disease can cause major ocular morbidity. They recommend treatment with antibiotics.

Figure/Illustration A is a clinical photograph showing erythema and inflammation surrounding the orbit (red circle). These findings are consistent with orbital cellulitis.

Incorrect Answers:
Answer 1: Infection anterior to the orbital septum is periorbital cellulitis and would not present with pain with extraocular movements. Treatment is with antibiotics.

Answer 3: Maxillary osteomyelitis would be less likely to present with orbital symptoms and periorbital edema. Treatment is with antibiotics and possible surgical debridement.

Answer 4: Meibomian gland infection or a stye would present with symptoms limited to the eyelid. Treatment is with compresses and supportive treatment. Antibiotics may be given in some instances, in particular, when cellulitis is present.

Answer 5: Thrombus within the cavernous sinus describes cavernous sinus thrombosis which would present with severe symptoms such as pain, diplopia, and headache with a much more concerning clinical picture. Treatment is with thrombolytic agents.

Bullet Summary:
Orbital cellulitis (infection posterior to the orbital septum) presents with inflammation, erythema, pain with extraocular movements, proptosis, and vision impairment.

ILLUSTRATIONS:
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