Periorbital vs Orbital Cellulitis: Difference between revisions
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===Background===
===Background===
*Must distinguish between these two conditions
*Must distinguish between these two conditions!
**Orbital cellulitis may mimic periorbital cellulitis early in its course  
 
**[[Orbital cellulitis]] may mimic [[periorbital cellulitis]] early in its course  
*Orbital cellulitis most often 2/2 ethmoid sinusitis
*Orbital cellulitis most often 2/2 ethmoid sinusitis
**May also be 2/2 orbital trauma, endophthalmitis, infectious infection from teeth / middle ear  
**May also be 2/2 orbital trauma, endophthalmitis, infectious infection from teeth / middle ear  
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==Concern for [[Orbital Cellulitis]]==
==ORBITAL CELLULITIS (vs. Periorbital)==
Any of the following:
Any of the following:
# Fever
# Fever
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# Edema of optic disk
# Edema of optic disk
# Venous engorgement of retina
# Venous engorgement of retina
==Diagnosis==
===Signs/Symptoms===
#Periorbital Cellulitis
##Swelling and erythema of tissues surrounding the orbit
##+/- pain with eye movement
##+/- fever
#Orbital Cellulitis
##All of the above plus:
###Proptosis
###Chemosis (conj. swelling)
###Globe displacement
###Limitation of eye movements
###Double vision
###Vision loss (indicates orbital apex involvement)
===Imaging===
#CT Orbit with IV contrast
##Indicated for suspected orbital cellulitis or in pts who cannot accurately assess vision (e.g. age <1yr)
##Findings c/w orbital cellulitis:
###Proptosis
###Inflammation of ocular muscles
###Subperiosteal or orbital abscess
==Complications==
# Subperiosteal Abscess
## Must be distinguished from orbital cellulitis based on CT
# Orbital Abscess
## Pts tend to have severe proptosis, globe displacement, and appear systemically ill
## May be clinically indistinguishable from orbital cellulitis; requires CT
# Meningitis
# Cavernous sinus thrombosis
==Treatment==
# Periorbital Cellulitis
## Most cases (except for pts < 1yr) can be managed as outpatient w/ oral abx and daily f/u
## Treatment (7-10 days)
### Augmentin 875mg BID OR
### Cefpodoxime 200mg BID OR
### Cefdinir 600mg qd
# Orbital Cellulitis
## Vancomycin +
### Ampicillin-sulbactam 3 g IV q6hr OR
### Ticarcillin-clavulanate 3.1 g IV q4h OR
### Piperacillin-tazobactam 4.5 g IV q6h OR
### Ceftriaxone 2 g IV q12hr OR
### Cefotaxime 2 g IV q4h
==Disposition==
*Periorbital Cellulitis
**If well-appearing and afebrile consider discharge
**If concern of hematogenous cause consider admission
*Orbital Cellulitis
**Admit


==See Also==
==See Also==
[[Periorbital Swelling]]
*[[Periorbital Swelling]]
*[[Orbital Cellulitis]]
*[[Periorbital Cellulitis]]


==Source==
==Source==

Revision as of 20:59, 14 July 2011

Background

  • Must distinguish between these two conditions!
  • Orbital cellulitis most often 2/2 ethmoid sinusitis
    • May also be 2/2 orbital trauma, endophthalmitis, infectious infection from teeth / middle ear
  • Periorbital cellulitis most often 2/2 contiguous infection of soft tissues of face and eyelids
  • Periorbital cellulitis does not lead to orbital cellulitis


Concern for Orbital Cellulitis

Any of the following:

  1. Fever
  2. Ill appearance
  3. Blurred vision
  4. Proptosis
  5. Painful/limited EOM
  6. Diplopia
  7. Edema of optic disk
  8. Venous engorgement of retina

See Also

Source

UpToDate

Tintinalli

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