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Paediatrics finals > Peri-orbital cellulitis > Flashcards

Peri-orbital cellulitis Flashcards

1
Q

What is periorbital cellulitis?

A

Infection of the peri-orbital soft tissue

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2
Q

Which age group does peri-orbital cellulitis tend to affect?

A

0-15yo

Peak incidence <10yo

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3
Q

Describe the seasonal variation of peri-orbital cellulitis

A

Bi-modal

Late winter/early spring

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4
Q

What causes peri-orbital sinusitis

A 
URTI
Paranasal sinusitis - Contiguous spread from surrounding periorbital structures 
Dacrocytis
Dental infections
Endophthalmitis 
Infection - impetigo
Foreign bodies
Insect bites 
Eyelid problems - chalazion and hordeola
Iatrogenic - eye and oral procedures
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5
Q

Name the two forms of peri-orbital cellulitis

A

Pre-septal (anterior to septum)

Post-septal (posterior to septum)

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6
Q

What divides the two forms of peri-orbital cellulitis?

A

Orbital septum

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7
Q

What is the orbital septum?

A

Thin, fibrous, multilaminated structure that attaches peripherally to the periosteum of the orbital margin to form the arcus marginalis

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8
Q

Which sinusitis is the most common cause of peri-orbital cellulitis in neonates and why?

A

Ethmoidal

Have not yet formed their frontal sinuses

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9
Q

When do the frontal sinuses develop?

A

Age 7

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10
Q

Why does peri-orbital cellulitis happen more in young children?

A

Thin dehiscent bone surface of their lamina papyracea and increased diplopic venous supply in comparison to adults
Incomplete immunological development

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11
Q

What used to be the most common organism causing peri-orbital cellulitis before the vaccine?

A

Haemophilus influenzae type B (Hib)

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12
Q

What is the most common organism which now causes peri-orbital cellulitis?

A

Staphylococcus aureus

streptococcus pneumoniae and other URTI causing bacteria

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13
Q

Give the common clinical presentation of pre-septal peri-orbital cellulitis

A

Eyelid oedema and erythema

Absence of orbital signs

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14
Q

What causes the oedema in peri-orbital cellulitis?

A

Impedance of drainage through ethmoid vessels

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15
Q

List some orbital signs of orbital cellulitis

A 
Proptosis
Ophthalmoplegia 
Decreased visual acuity 
Loss of red colour vision 
Chemosis (swelling of conjunctiva)
Painful diplopia
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16
Q

What classification is used for peri-orbital cellulitis?

A

Chandler classification

17
Q

Describe the chandler classification

A

Type 1 - pre-septal cellulitis - confined to eyelid
Type 2 - post septal, orbital cellulitis - extends to orbital tissue
Type 3 - Subperiosteal abscess - abscess forms deep to the periosteum of the orbit
Type 4 - Intra-orbital abscess - collection of pus inside the muscle cone
Type 5 - cavernous sinus thrombosis - Infection in the cavernous sinus

18
Q

Which cranial nerves are involved in cavernous sinus thrombosis?

A

3rd
5th
6th

19
Q

How is per-orbital cellulitis diagnosed?

A

History - preceding URTI or sinusitis
Examination - vital signs, anterior rhinoscopy (nasal mucosa and middle meatus), dentition, ophthalmic examination (eye movement, visual acuity, pupillary response, tonometry, anterior segment bio microscopy, ophthalmoscopy), neurological examination
Swab discharge for MC&S
Sepsis screen - FBC, CRP, Blood cultures, U&Es, ABG and lactate
CT or MRI - visualise extent and abscesses

20
Q

What are some differentials of peri-orbital cellulitis?

A

Vesicles of herpes zoster opthalmicus
Erythematous irritation of contact dermatitis
Raised, dry plaques of atopic dermatitis
Stye
Chalazion
Blepharitis
Dacryocysitis (infection of lacrimal sac)

21
Q

How is mild pre-septal cellulitis treated?

A

Outpatient

Oral empiric broad spectrum ABX

22
Q

How is moderate/severe post-septal cellulitis treated?

A

Hospital admission
IV broad spectrum ABX - Gram positive and negative cover
Nasal decongestants
Steroid nasal drops
Nasal douching
Urgent drainage if intracranial complications

23
Q

What are the complications of peri-orbital cellulitis?

A 
Loss of vision
Abscess formation 
Cavernous sinus thrombosis 
Encephalomeningitis 
Sepsis

Paediatrics finals (37 decks)

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