Orbital Cellulitis and Periorbit

Question 1

Presentation

Differentiating symptoms

Answer 1

Acute onset swelling, fever, eyelid oedema.

Orbital will have pain with eye movement, diplopia, reduced visual acuity, proptosis.

If previous bacterial sinusitis, then orbital more likely.

Question 2

Investigations

Answer 2

CT head and orbit
FBC, UandE, CRP
Swabs and culture if discharge

Question 3

Management

Answer 3

Periorbital cellulitis - Co-amoxiclav, if allergic, erythromycin?

Orbital - Co-amox, IV if acute. If allergy, metronidazole with clindamycin.

Question 4

Complications

Answer 4

Periorbital/preseptal -
Transition to orbital cellulitis.
Lid necrosis, abscess.

Orbital -
Raised intra-occular pressure
Retinal artery or vein occlusion
Meningitis, brain abscess
Cavernous sinus thrombosis