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orbital cellulitis
Etiology:
- associated conditions
- sinusitis
- dental infection
Pathology:
- inflammation of structures of the orbit, including extraocular muscles & orbital fat
- bacterial infection that involves the soft tissue posterior the orbital septum
Clinical manifestations:
1) swelling & erythema of the eyelids & conjunctiva (chemosis)
2) unilateral proptosis may be present
3) ophthalmoplegia: restriction of eye movements
4) afferent pupillary defect
5) eye pain
- pain with eye movement
6) visual impairment when severe
7) fever
Laboratory:
- complete blood count (CBC) may show leukocytosis
- Gram stain
- culture both aerobic & anaerobic media
- collect purulent material from the nose with a cotton or calcium alginate swab
- fine needle aspiration of the orbit is contraindicated [3]
Radiology:
- CT scan or MRI of the sinuses & orbit
Complications:
- cavernous sinus thrombosis
- hearing loss
- septicemia
- meningitis
- optic nerve damage & loss of vision
Differential diagnosis:
- optic neuritis
- loss of color vision affected more severely than visual acuity
- no fever or chemosis
- acute angle-closure glaucoma
Management:
- admit to hospital
- fever, leukocytosis
- failure of oral antibiotics
- immunosuppression [5]
- intravenous antibiotics targeting likely organisms
a) Streptococcus
b) Staphylococcus
- immediate referral to or consultation with ophthalmologist
General
orbital inflammation
eye infection (ocular infection)
cellulitis
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 17, 18.
American College of Physicians, Philadelphia 1998, 2009, 2015, 2018.
- PubMed Health: Orbital Cellulitis
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002007/
- Harrington JN
eMedicine (Medscape): Orbital Cellulitis
http://emedicine.medscape.com/article/1217858-overview
- Gelston CD.
Common eye emergencies.
Am Fam Physician. 2013 Oct 15;88(8):515-9. Review.
PMID: 24364572 Free Article
- NEJM Knowledge+ Ophthalmology