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Orbital disorders (PEARLS)

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Feature Orbital Cellulitis Preorbital (Periorbital) Cellulitis
  Orbital cellulitis - no watermark Celulitis Periorbitaria (Preseptal)
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)
ReelDx Virtual Rounds (Orbital cellulitis)
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

Orbital cellulitis

Photograph showing orbital cellulitis

RtmaxobitinfectteethCT

A left maxillary sinusitis (dark arrow) and facial/orbital cellulitis (empty arrow)

Periorbital (Preseptal) Cellulitis
Patient will present as → a 5-year-old child presents with unilateral eye swellingredness, 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

Papilledema (ReelDx) (Prev Lesson)
(Next Lesson) Orbital cellulitis (ReelDx)
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