Orbital disorders (PEARLS)
NCCPA™ PANCE EENT Content Blueprint eye disorders ⇒ orbital disorders
Feature |
Orbital Cellulitis |
Preorbital (Periorbital) Cellulitis |
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Definition |
Infection involving the eye tissues posterior to the orbital septum |
Infection involving the tissues anterior to the orbital septum |
Etiology |
Often secondary to sinusitis, trauma, or surgery |
Commonly follows local trauma, insect bites, or conjunctivitis |
Common Pathogens |
Staphylococcus aureus, Streptococcus species, Haemophilus influenzae |
Staphylococcus aureus, Streptococcus species |
Age Group |
More common in children and young adults |
More common in children |
Clinical Features |
Painful eye movement, proptosis, ophthalmoplegia, decreased vision, fever |
Eyelid swelling and erythema, fever may be present |
Eye Movement |
Painful and restricted |
Normal and painless |
Vision |
May be impaired |
Usually normal |
Proptosis |
Present (eye bulging) |
Absent |
Systemic Symptoms |
Fever, malaise, potentially severe illness |
Fever may be present but systemic symptoms are less severe |
Diagnosis |
Clinical examination, CT or MRI to assess extent and complications |
Clinical examination, CT scan to rule out orbital cellulitis if severe |
Complications |
Abscess formation, vision loss, cavernous sinus thrombosis, intracranial spread |
Rare, but can progress to orbital cellulitis if untreated |
Management |
Hospitalization, intravenous antibiotics, possible surgical drainage |
Oral antibiotics, outpatient management unless severe or unresponsive |
Prognosis |
Requires prompt treatment to prevent serious complications |
Good with appropriate antibiotic therapy, fewer complications |
Orbital cellulitis (ReelDx) |
Orbital cellulitis
You are called to see a 49 y/o with swelling and redness around the eye
Patient
Vitals
- Temperature: 98.4 F/36.9 C
- Blood Pressure: 153/93
- Heart Rate: 83
- Respiratory Rate: 18
- Pulse Oximetry: 97%
Signs and Symptoms
- Swelling and redness around the eye
Click here to work through this patient case simulation.
Patient will present as → a 2-year-old who arrives at the ED with a swollen and erythematous eyelid, proptosis, pain with movement of the eye, and an inability to adduct or abduct his eye.
Orbital cellulitis is a serious infection of the eye and the eye structures within the bony cavity of the face. Symptoms include swelling, redness, and pain around the eye, as well as decreased eye movement and vision.
- Often associated with sinusitis. It occurs more often in children than adults
DX: History, clinical exam, and focused assessment of extraocular muscles
- The imaging modality of choice for the diagnosis of orbital cellulitis is CT with contrast
- CBC and blood culture may be standard in some settings
TX: Hospitalization and IV broad-spectrum antibiotics
 Photograph showing orbital cellulitis
 A left maxillary sinusitis (dark arrow) and facial/orbital cellulitis (empty arrow)
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Patient will present as → a 5-year-old child presents with unilateral eye swelling, redness, and pain. The child had a recent upper respiratory infection. On examination, the eyelid is erythematous and swollen, but the eye itself is not protruding, and the child can move the eye without pain. There are no signs of proptosis, ophthalmoplegia, or visual impairment, which would suggest orbital cellulitis. The child is treated with oral antibiotics, and close follow-up is ensured to monitor for any progression to orbital cellulitis.
Periorbital (Preseptal) Cellulitis is an infection of the eyelid and surrounding skin anterior to the orbital septum
- Typically caused by skin trauma, insect bites, or sinusitis
- Erythema, swelling, and tenderness of the eyelid
- No proptosis, ophthalmoplegia, or pain with eye movements (distinguishes from orbital cellulitis)
- Common pathogens include Staphylococcus aureus (including MRSA), Streptococcus species, and Haemophilus influenzae
- May be associated with fever and systemic symptoms
DX: clinically, but a CT scan can be used if orbital cellulitis is suspected
TX: with oral antibiotics (e.g., amoxicillin-clavulanate or clindamycin) for mild cases; IV antibiotics for more severe cases or if orbital cellulitis cannot be ruled out |
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