PANCE Blueprint EENT (7%)

49 y/o with swelling and redness around the eye

Patient will present as →  a 49-year-old man presents to the emergency department with a 2-day history of right eye pain, swelling, and decreased vision. On examination, he has proptosis, ophthalmoplegia (paralysis of the extraocular muscles), and chemosis of the right eye. His temperature is 101°F (38.3°C), and blood cultures are pending. A CT scan of the orbits shows evidence of an abscess in the right orbit.

Orbital cellulitis is an infection of the orbital muscles and fat behind the eye (differentiate from periorbital cellulitis, which is only an infection of the skin)

• Patients will present with decreased extraocular movement (ophthalmoplegia), pain with movement of the eye, and proptosis (protrusion of the eye)
• May present with fever, decreased vision, and diplopia
• Often associated with untreated sinusitis. It occurs more often in children than adults - ages 7-12 y/o
• Common pathogens include Staphylococcus aureus, Streptococcus species, and Haemophilus influenzae
• Decreased vision is a rare manifestation of orbital cellulitis

Involvement of muscles and fat behind the eye

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

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

If orbital cellulitis/abscess is seen on CT, it requires an ophthalmology evaluation

• Hospitalization and IV broad-spectrum antibiotics
• Vancomycin + ceftriaxone/cefotaxime is used in the empiric treatment of orbital cellulitis to cover methicillin-resistant Staphylococcus aureus (MRSA)