Orbital Cellulitis Flashcards
(40 cards)
What is Orbital cellulitis?
Orbital cellulitis involves infection of the muscle and fat within the orbit, posterior to the orbital septum.
Who is it most common in?
Children (16 times more common in children than adults)
What can orbital cellulitis lead to?
Loss of sight
(11% of patients will have visual loss following orbital cellulitis)
What is orbital cellulitis caused by?
Orbital cellulitis is commonly caused by a local spreading infection from acute bacterial sinusitis, typically from the paranasal sinuses
What are some less common causes of Orbital cellulitis?
- Peri- orbital cellulitis
- Haematogenous spread
- orbit trauma
- contiguous spread from the face or teeth from recent surgery or dental infection
What are some typical symptoms of orbital cellulitis?
Erythema and swelling around the eye
Blurred vision
Painful eye movements
Change in colour vision
Fever
What should be determined in a history following orbital cellulitis?
Past medical history: previous episodes of eye disease including any previous episodes of peri-orbital/orbital cellulitis
History of precipitating cause: for example orbital trauma, sinusitis, or dental infection
Duration of symptoms
Laterality (unilateral or bilateral)
Severity of symptoms (worsening, stable or improvement in symptoms since start)
What examinations should be performed?
- Nasal Examination
- Oral cavity
- Eyes and vision
- Neurological
During a nasal examination, what should be looked for?
ipsilateral nasal discharge/mucus
What should be looked for during an oral cavity examination?
assessing oral hygiene, any evidence of dental disease, and any recent dental treatment of the upper molars
What should be assessed during an eye and vision examination?
including assessment of visual fields, visual acuity, colour vision, relevant afferent pupillary defect (RAPD), light reflexes, proptosis measurement of intraocular pressure and slit lamp examination.
What should be assessed during a neurological examination?
cranial nerve examination including assessment for meningism
What are typical clinical findings for orbital cellulitis?
Severe eye redness and swelling
Fever
Painful eye movements*
Reduced visual acuity and/or visual fields *
Proptosis *
Relevant afferent pupillary defect (RAPD): Marcus-Gunn pupil *
Chemosis *
Altered colour vision *(red-green tends to be the first colours lost)
What may bilateral eye signs indicate?
avernous sinus thrombosis
What would Nausea, vomiting, headache, neck stiffness indicate?
intracranial involvement
What laboratory investigations would be involved?
Full blood count
C-reactive protein (CRP)
Lactate
Blood cultures
Microscopy, culture and sensitivity
What would a full blood count show for a patient with orbital cellulitis?
may show elevated white cell count, particularly neutrophilia
What would CRP show for a patient with orbital cellulitis?
may be elevated
What would lactate show for a patient with orbital cellulitis?
may be raised if the patient is septic
What would blood cultures show for a patient with orbital cellulitis?
the most common isolated organisms include Staphylococcus, Streptomyces species and Haemophilus
What type of imaging would be used for orbital cellulitis?
Contrast-enhanced CT orbit, sinuses and brain is the imaging modality of choice.
Why is imaging required?
Imaging is required to assess for complications of orbital cellulitis (including abscess formation or intracranial involvement) and to guide ongoing management
When would we use imaging for orbital cellulitis?
Imaging is indicated if clinical examination of the eye is not possible, there are any red flag eye signs, or there is a failure to improve (e.g. ongoing pyrexia) after 36-48 hours of intravenous antibiotics.
When may a MR venogram be used?
to aid the diagnosis of cavernous sinus thrombosis
