Flashcards in Lecture 2 - Orbital Infection to Wegeners Deck (66)
Fascia behind the orbicularis, between the orbital rim and tarsus, serves as a BARRIER BETWEEN LIDS AND ORBIT
superior orbital septum blends with the tendon of which lid muscle
inferior orbital septum blends with which lid muscle?
Chandler classification for infections of the orbit and adnexa: What is stage 1?
NORMAL septum - preseptal cellulitis
Chandler classification for infections of the orbit and adnexa: What is stage 2?
Diffuse cellulitis - contained in cone and EOMs
Chandler classification for infections of the orbit and adnexa: what is stage 3?
Subperiosteal abscess - abscess outside of the muscle cone
Chandler classification for infections of the orbit and adnexa: what is stage 4?
Abscess contained within the orbit
Chandler classification for infections of the orbit and adnexa: what is stage 5?
Cavernous sinus thrombosis
Infection of the soft tissue of eye lids anterior to the orbital septum - no involvement of globe and orbit - injury, bites, conjunctivitis, sinusitis, chalazion - Usually Staph Aureus or Strep
What 2 anaerobic bacteria should be suspected in cases involving preseptal cellulitis caused by human or ANIMAL bites?
peptostreptococcus and bacteroides
which bacteria should be suspected in preseptal cellulitis cases caused by skin trauma: laceration or INSECT bites
S. Aureus, S. Pyogenes
From where in the body can bacteria travel hematogenously to cause a remote infection in the form of preseptal cellulits? (2)
upper respiratory tract or middle ear
Is Preseptal cellulitis unilateral? is there proptosis or EOM restriction? can the eye always open? are VA's affected? What are the symptoms you would expect? what will a CT show?
unilateral, no proptosis/restriction, cant always open eye, No VA effect, fever, redness/ tenderness/ irritable children - Opacification anterior to septum
What is unique about preseptal cellulitis cases that are caused by H. Influenza?
Red-Purplish in color, important to ask about vaccines
You suspect preseptal cellulitis, but upon further testing, you observe proptosis, pain with EOM test, decreased VA, fever, and chemosis. What is the differential diagnosis?
You suspect preseptal cellulitis, but then observe acute inflammation (not entire lid area), a palpable mass, and pointy meibomian gland. What is the diferential diagnosis?
You suspect preseptal cellulitis, but upon further testing you find there was sudden onset, itching, redness, a history of allergies, and the patient began using a new kind of eye product (cls solution, drops etc) . What is the differential diagnosis?
Swelling of the eyelid due to an allergic reaction
You suspect preseptal cellulitis, but upon further testing you find proptosis, paresis (partial paralysis- weakness) of III, IV, VI bilaterally, and decreased sensation of 1st (ophthalmic- upper eye lid, forehead, cornea, nose) and 2nd division (maxillary- teeth, mouth) of CN V, What is the differential diagnosis?
Cavernous sinus thrombosis
You suspect preseptal cellulitis, but find a rapid streptococcal cellulitis with CLEAR DEMARCATION, fever, and chills. what is the likely cause?
Erysipelas- acute, recurrent bacterial infection with large raised patches, especially on the face
We cannot just assume that preseptal cellulitis is in fact preseptal. in order to determine if the infection has spread to the septum, what tests can we do to rule out orbital cellulitis?
VA's - loss = orbital cellulitis
EOM's- pain= orbital cellulitis
Presence of proptosis
Direct/Consensual Pupillary Response - RAPD = Orbital cellulitis
A CT scan should be ordered if you suspect what alternatives? How should the CT look if your initial diagnosis of preseptal cellulitis is correct?
Significant trauma or Intra-Ocular Foreign Body. CT will show opacification strictly anterior to the septum
If the area appearing as preseptal cellulitis has an open wound or drainage, what tests need to be ordered?
gram stain and bacterial culture
Why would you palpate the perioribital area, head, and neck lymph nodes if you see what appears as preseptal cellulitis?
There could be a lymphoma or other lacrimal gland mass giving the appearing of preseptal swelling
So all signs lead to preseptal cellulitis, how do you treat it? Lets say the patient is a child older than 5, no fever? (2 choices) - dont worry about doses
Augmentin - Amoxicillin AB and Clavulanate -- beta lactamase inhibitor) - 20 mg per kg divided into 3 doses
Cefaclor (ceclor) - 2nd gen cephalosporin - inhibits cell wall synthesis - 1 g/day
So all signs lead to preseptal cellulitis, how would you treat an adult patient? (3)
Augmentin or Ceclor or Dicloxacillin
All of your testing lead to a positive diagnosis of preseptal cellulitis in an Adult person who is known to be allergic to penicillins, how should you treat it?
Bactrim - Trimethoprim and sulfamethazole
Penicillins that can be used to treat Presptal Cellulitis
Flucloxacillin, Dicloxacillin, Cloxacillin
Cephalosporins used to treat Preseptal Cellulitis - When are they the best to use?
Ceclor, Cephalexin, Cefadroxil, Cephradine
Best for Kids, especially with Gram + infection
Macrolides that can be used to treat Preseptal cellulitis, when are they not good to be used?
Azithromycin Z-pack or Clarithromycin
Not good against Gram - bacteria like H. INFLUENZA