Periorbital/Preseptal and orbital cellulitis

Question 1

Periorbital refers to tissues infront of the septum. Orbital cellulitis refers to tissues behind the orbital septum. Cellulitis refers to an infection. Which of the following is NOT involved in preseptal cellulitis?

1 - eyelids
2 - muscles of the eye
3 - skin
4 - subcutaneous tissue of the face

Answer 1

2 - muscles of the eye

Question 2

In all suspected cases of preseptal or orbital cellulitis, which of the following should always be asked in the history?

1 - recent sinusitis
2 - insect bites
3 - infected lid lesions
4 - history of trauma
5 - all of the above

Answer 2

5 - all of the above

Question 3

What is the incidence of preseptal cellulitis?

1 - 1 cases per 100,000
2 - 10 cases per 100,000
3 - 100 cases per 100,000
4 - 1000 cases per 100,000

Answer 3

2 - 10 cases per 100,000

Equally as common in males and females

Question 4

What age does the incidence of preseptal cellulitis peak at?

1 - 6-15 years
2 - 20-35 years
3 - 40-60 years
4 - >65 years

Answer 4

1 - 6-15 years

Question 5

Is preseptal or orbital cellulitis more serious?

Answer 5

• orbital cellulitis

Orbit has no lymph nodes, so no immune system
Offers a direct passage through to the brain

Question 6

Preseptal cellulitis typically is caused by an break in the skin, sinusitis, or respiratory tract infection that spreads to the structures surrounding the orbit. All of the following organisms can causes this, but which is the most common cause?

1 - Staphylococcus aureus
2 - Staphylococcus epidermidis
3 - streptococci
4 - anaerobic bacteria

Answer 6

1 - Staphylococcus aureus

Question 7

Patients typically present with all of the following in preseptal cellulitis, EXCEPT which one?

1 - acute onset of pain
2 - pain upon moving the eye
3 - red eye
4 - swollen eye
5 - fever like symptoms

Answer 7

2 - pain upon moving the eye

Common in orbital cellulitis, but not preseptal cellulitis

Question 8

Can ptosis (drooping of the eyelid) occur in preseptal cellulitis?

Answer 8

• yes

Can be complete or partial depending on the swelling of the eyelids

Question 9

Which of the following diagnostic tests would NOT typically be performed in preseptal cellulitis?

1 - blood inflammatory markers
2 - swab of eye
3 - blood cultures
4 - CT with contrast of eye
5 - clinical examination

Answer 9

4 - CT with contrast of eye

ALWAYS performed in orbital cellulitis, but not preseptal cellulitis

Question 10

All of the following are likely differentials for preseptal cellulitis, but which is most likely?

1 - allergic reaction
2 - orbital cellulitis
3 - trauma
4 - thyroid eye disease

Answer 10

2 - orbital cellulitis

Question 11

Do patients with preseptal cellulitis always need to be referred to secondary care?

Answer 11

• yes

Important to rule out orbital cellulitis

Question 12

In preseptal cellulitis, how are patients treated typically?

1 - topical antibiotics
2 - debridement and washout
3 - oral antibiotics
4 - wait and see

Answer 12

3 - oral antibiotics

Typically amoxicillin

Question 13

What is the most concerning complication of preseptal cellulitis?

1 - scarring
2 - rhinitis
3 - orbital cellulitis
4 - conjunctivitis

Answer 13

3 - orbital cellulitis

Question 14

What is the incidence of orbital cellulitis?

1 - 1 cases per 100,000
2 - 10 cases per 100,000
3 - 100 cases per 100,000
4 - 1000 cases per 100,000

Answer 14

1 - 1 cases per 100,000

Question 15

What age does the incidence of orbital cellulitis peak at?

1 - 6-15 years
2 - 20-35 years
3 - 40-60 years
4 - >65 years

Answer 15

1 - 6-15 years

Question 16

Which of the following is NOT a risk factor for developing orbital cellulitis?

1 - old age
2 - previous sinus infection
3 - no haemophilus influenzae type b (Hib) vaccination
4 - recent eyelid infection/ insect bite on eyelid (Peri-orbital cellulitis)
5 - ear or facial infection

Answer 16

1 - old age

Orbital and preseptal cellulitis is more common in children 6-15 years old

Question 17

Patients can present with all of the following in orbital cellulitis, EXCEPT which one?

1 - severe ocular pain
2 - no pain upon moving the eye
3 - red and swelling around the eye
4 - swollen eye with exophthalmos
5 - fever like symptoms
6 - visual disturbance
7 - meningeal involvement (Rare)

Answer 17

2 - no pain upon moving the eye

There is extreme pain when moving the eye

Question 18

In orbital cellulitis, can complete ophthalmoplegia (inability to move eye in any direction) occur?

Answer 18

• yes

Can also lead to optic nerve compression

Question 19

Can ptosis (drooping of the eyelid) occur in orbital cellulitis?

Answer 19

• yes

Can be complete or partial depending on the swelling of the eyelids

Question 20

All of the following diagnostic tests can be performed in orbital cellulitis, but which one MUST be performed in orbital cellulitis is suspected?

1 - blood inflammatory markers
2 - swab of eye
3 - blood cultures
4 - CT with contrast of eye
5 - clinical examination

Answer 20

4 - CT with contrast of eye

Also good for ruling out a periorbital abscess

Question 21

Which of the following are likely differentials for orbital cellulitis?

1 - allergic reaction
2 - preseptal cellulitis
3 - trauma
4 - thyroid eye disease
5 - periorbital abscess
5 - all of the above

Answer 21

5 - all of the above

Question 22

Do patients with orbital cellulitis always need to be referred to secondary care?

Answer 22

• yes

Can be very dangerous

Question 23

In orbital cellulitis, how are patients treated typically?

1 - topical antibiotics
2 - IV antibiotics and hospital admission
3 - oral antibiotics
4 - wait and see

Answer 23

2 - IV antibiotics and hospital admission

These would be broad spectrum antibiotics

Question 24

Which 2 of the following are the most dangerous complications that can occur if the infection causing orbital cellulitis begins tracking to the brain?

1 - occlusion of lacrimal vein
2 - cavernous sinus thrombosis
3 - encephalitis
4 - ocular nerve palsy

Answer 24

2 - cavernous sinus thrombosis
3 - encephalitis
- inflammation of the brain