orbital cellulitis and herpes zoster opthalmolicus

Question 1

preseptal cellulitis

not spread pass where

Answer 1

Preseptal cellulitis refers to infection of tissue not spreading past the orbital septum.

Question 2

cx of preseptal and fx

Answer 2

It is commonly caused by sinusitis or damage to the overlying skin.

Clinical features
The typical patient is a child with an erythematous swollen eyelid, mild fever and erythema surrounding the orbit

Question 3

tx of septal

Answer 3

Treat with intravenous empirical antibiotics. If there is doubt over the diagnosis, treat it as orbital cellulitis.

Question 4

orbital cellultiis 3 importnat sx

Answer 4

Orbital cellulitis presents similarly to preseptal cellulitis, but there are 3 important features that set it apart:

Painful eye movements
Diplopia
Visual impairment

Question 5

cx of orbital

Answer 5

sinusitis or URTI

Question 6

sx

Answer 6

feverish child with a swollen eyelid, reduced eye mobility
painful eye movements
diplopia
reduced visual acuity
relative afferent pupillary defect. Proptosis(eye out) may also be present.
Visual loss may occur due to compression of the optic nerve or optic neuritis.
Death may occur due to cavernous sinus thrombosis or intracranial spread of infection

Question 7

mx of orbital cellulitis

Answer 7

Patients should be admitted for immediate CT scan, ENT review and urgent intravenous antibiotics.

Question 8

3 condtions associated with kayser-fleischer rings

Answer 8

cholestasis and primary biliary cirrhosis and wilsons disease

Question 9

sx herpes simplex keratitis

Answer 9

pain
photophobia
epiphora(excess lacrimination).
Under slit lamp examination with fluorescein applied, dendritic ulcers may be seen, which are pathognomonic of the infection.

Question 10

Herpes Zoster Ophthalmicus

Answer 10

Herpes zoster ophthalmicus usually presents with a painful red eye
fever
malaise
headache
Sx precede the typical erythematous vesicular rash over the trigeminal division of the ophthalmic nerve( need to give abx within 4 days of this)

The virus, which remains dormant in the trigeminal ganglion, invades the cornea which is supplied by the ophthalmic division of the trigeminal nerve, and causes redness, inflammation (keratitis), pain and sight loss.

Question 11

what is hutchisnosn signs

Answer 11

a skin lesion on the tip or side of the nose

Question 12

herpes zoster managemtn

Answer 12

oral aciclovir(7-10days) +/- topical steriods( treat secondary infection if needed)- therfore not always given

Question 13

how do you know if there is orbital involvement with herpes zoster opthalmicus

Answer 13

A skin lesion on the tip or side of the nose, known as Hutchinson’s sign, is a strong predictor of ocular involvement.

gone through nerve root
commonly affects nerve root V1 - so goes in triangle over eye and nose
can lead to corneal ulceraion

Question 14

most common complication of HZO

Answer 14

post-herpetic neuralgia - burning pain in nerves and the skin