Orbital cellulitis

Question 1

What are the causes of orbital cellulitis?

Answer 1

• Most commonly secondary to ethmoidal sinusitis (through lamina papyracea)
• poorly controlled DM, immunocompromised
• Infection of adjacent structures (facial, dacryocystitis, dental abscess, URTI)
• Trauma or surgical (orbital, lacrimal)

Question 2

what are the organisms that can cause orbital cellulitis?

Answer 2

Staph. aureus, Strep. pneumoniae, Strep. pyogenes, Haemophilus influenza

Question 3

what is orbital cellulitis?

Answer 3

inflammation of the soft tissues of the eye socket behind the orbital septum, a thin tissue which divides the eyelid from the eye socket

Question 4

what is preseptal cellulitis?

Answer 4

infection of subcutaneous tissues anterior to the orbital septum

Question 5

what are the symptoms of orbital cellulitis?

Answer 5

• Painful red eye, with lid oedema in a child with a recent URTI is the typical presentation of orbital cellulitis.
• Acute onset
• Periorbital swelling & redness
• Pain
• Visual – blurring, diplopia
• Systemic – fever, malaise, toxic, may have preceding symptoms of sinusitis (e.g. facial pain, rhinorrhoea)

Question 6

what are the signs of orbital cellulitis?

Answer 6

C – Chemosis and severe injection of the conjunctiva

R – RAPD, reduced VA, reduction of colour vision (optic neuropathy)

O – Ophthalmoplegia (restricted EOM)

P – Proptosis, pain on EOM

S – Swollen optic disc (compressive optic neuropathy)

S – Swollen, tender, erythematous eyelids (does NOT differentiate preseptal vs orbital)

Question 7

what are the ocular complications or orbital cellulitis?

Answer 7

• Compressive optic neuropathy, optic neuritis
• Raised IOP
• CRAO, CRVO
• Exposure keratopathy

Question 8

what are the systemic complications or orbital cellulitis?

Answer 8

• Subperiosteal abscess
• Orbital abscess
• Cavernous sinus thrombosis
• meningitis

Question 9

what is the management of orbital cellulitis?

Answer 9

• **URGENT admission + URGENT ENT referral for sinus drainage and washout
• IV broad spectrum abx (Augmentin + metronidazole)
• If CT shows subperiosteal abscess 🡪 Sx drainage STAT
• If CT shows no subperiosteal abscess 🡪 close monitoring of vision (visual acuity, IOP, pupillary reaction, etc)
• STAT endoscopic sinus surgery (drain ethmoid sinus to remove source of infection) if:
• -> Refractory to abx, i.e. symptoms do not respond in 24h, or visual acuity worsens
• -> High risk of progression, e.g. immunocompromised