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Y3 - Acute Emergency Core Conditions > Orbital Cellulitis > Flashcards

Orbital Cellulitis Flashcards

1
Q

What is Orbital cellulitis?

A

Orbital cellulitis involves infection of the muscle and fat within the orbit, posterior to the orbital septum.

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2
Q

Who is it most common in?

A

Children (16 times more common in children than adults)

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3
Q

What can orbital cellulitis lead to?

A

Loss of sight
(11% of patients will have visual loss following orbital cellulitis)

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4
Q

What is orbital cellulitis caused by?

A

Orbital cellulitis is commonly caused by a local spreading infection from acute bacterial sinusitis, typically from the paranasal sinuses

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5
Q

What are some less common causes of Orbital cellulitis?

A
  • Peri- orbital cellulitis
  • Haematogenous spread
  • orbit trauma
  • contiguous spread from the face or teeth from recent surgery or dental infection
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6
Q

What are some typical symptoms of orbital cellulitis?

A

Erythema and swelling around the eye
Blurred vision
Painful eye movements
Change in colour vision
Fever

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7
Q

What should be determined in a history following orbital cellulitis?

A

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)

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8
Q

What examinations should be performed?

A
  • Nasal Examination
  • Oral cavity
  • Eyes and vision
  • Neurological
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9
Q

During a nasal examination, what should be looked for?

A

ipsilateral nasal discharge/mucus

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10
Q

What should be looked for during an oral cavity examination?

A

assessing oral hygiene, any evidence of dental disease, and any recent dental treatment of the upper molars

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11
Q

What should be assessed during an eye and vision examination?

A

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.

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12
Q

What should be assessed during a neurological examination?

A

cranial nerve examination including assessment for meningism

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13
Q

What are typical clinical findings for orbital cellulitis?

A

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)

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14
Q

What may bilateral eye signs indicate?

A

avernous sinus thrombosis

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15
Q

What would Nausea, vomiting, headache, neck stiffness indicate?

A

intracranial involvement

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16
Q

What laboratory investigations would be involved?

A

Full blood count
C-reactive protein (CRP)
Lactate
Blood cultures
Microscopy, culture and sensitivity

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17
Q

What would a full blood count show for a patient with orbital cellulitis?

A

may show elevated white cell count, particularly neutrophilia

18
Q

What would CRP show for a patient with orbital cellulitis?

A

may be elevated

19
Q

What would lactate show for a patient with orbital cellulitis?

A

may be raised if the patient is septic

20
Q

What would blood cultures show for a patient with orbital cellulitis?

A

the most common isolated organisms include Staphylococcus, Streptomyces species and Haemophilus

21
Q

What type of imaging would be used for orbital cellulitis?

A

Contrast-enhanced CT orbit, sinuses and brain is the imaging modality of choice.

22
Q

Why is imaging required?

A

Imaging is required to assess for complications of orbital cellulitis (including abscess formation or intracranial involvement) and to guide ongoing management

23
Q

When would we use imaging for orbital cellulitis?

A

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.

24
Q

When may a MR venogram be used?

A

to aid the diagnosis of cavernous sinus thrombosis

25
Q

What is recommended if meningeal signs develop?

A

Lumbar puncture

26
Q

What imaging should be used to exclude raised intercranial pressure?

A

CT head

27
Q

What medical management is used for Orbital cellulitis?

A

Patients with orbital cellulitis require intravenous antibiotics, for seven to ten days.

28
Q

What is needed if an orbital collection is seen on imaging?

A

evacuation of orbital pus or drainage of paranasal sinus pus may be required.

29
Q

What is Chandler’s classification?

A

Chandler’s classification anatomically categorises orbital complications of acute rhinosinusitis (the most common cause of orbital cellulitis).

30
Q

What is Group 1 of chandler’s classification?

A

Group 1: Pre-septal cellulitis (infection anterior to orbital septum

31
Q

What is Group 2 of chandler’s classification?

A

Group 2: Orbital cellulitis (infection posterior to orbital septum)

32
Q

What is Group 3 of chandler’s classification?

A

Group 3: Subperiosteal abscess (pus collection between bone and periosteum)

33
Q

What is Group 4 of chandler’s classification?

A

Group 4: Intraorbital abscess (pus collection within the orbit)

34
Q

What is Group 5 of chandler’s classification?

A

Group 5: Cavernous sinus thrombosis (mural thrombus which may propagate centrally)

35
Q

How is Grade 1 treated?

A

medically with antibiotics

36
Q

How is Grade 2 treated?

A

Grade 2 can also be treated medically however if there is no improvement surgical drainage should be considered

37
Q

How is grade 3 and grade 4 treated?

A

Grade 3 and 4 can be treated surgically (drainage endoscopically or externally)

38
Q

How is grade 5 treated?

A

Grade 5 should be treated with anticoagulation as well as surgical drainage

39
Q

What are some complications of orbital cellulitis?

A

Cavernous sinus thrombosis
Loss of vision
Intracerebral abscess
Meningitis
Death (rarely)

40
Q

Key Points:

A

Orbital cellulitis is a sight-threatening infection in the muscle and fat within the orbit, posterior to the orbital septum.
Orbital cellulitis is commonly caused by contiguous spread of paranasal sinusitis.
Clinical features include a painful red eye with proptosis, chemosis, painful eye movements, and decreased acuity.
Initial investigations include an endonasal swab and FBC, CRP, and lactate. Imaging may include CT orbit, sinuses and brain.
Medical management includes treatment with intravenous antibiotics, with surgery reserved for more complicated orbital cellulitis.
If not recognised and treated promptly there is a risk of visual loss, intracranial spread and rarely death

Y3 - Acute Emergency Core Conditions (9 decks)

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