Periorbital and Orbital Infections Morning Report 7/10/09

Swollen Eye Differential Diagnosis Noninfectious Causes Periorbital (Preseptal) Orbital

Noninfectious Causes Blunt Trauma-increased swelling x48hrs then resolves over several days Tumor-gradual onset of proptosis in the absence of inflammation Hemangiomas of the lid Ocular tumors-retinoblastoma, choroidal melanoma Orbital neoplasms-neuroblastoma, rhabdomyosarcoma

Noninfectious Causes Cont. Local edema-hypoproteinemia and congestive heart failure Bilateral Boggy Nontender Nondiscolored Allergic inflammation Contact hypersensitivity Angioneurotic edema

Anatomy

Anatomy

“Preseptal Cellulitis” Local infections Conjunctivitis Hordeolum Chalazion Dacryoadenitis Dacryocystitis Bacterial Cellulitis (trauma) Hematogenous dissemination Bacterial periorbital cellulitis Acute Sinusitis-inflammatory edema

“Orbital Cellulitis” Acute Sinusitis Hematogenous dissemination Subperiosteal Abscess Orbital Abscess Orbital Cellulitis Cavernous Sinus Thrombosis Hematogenous dissemination Traumatic inoculation

Symptoms Eye Pain with movement or Restricted eye movement Painful swelling of upper and lower lids Proptosis Decreased Visual Acuity Fever Ill appearing

History Recent sinusitis or upper respiratory tract infection Fever or malaise Recent facial trauma or surgery, dental work Infection elsewhere in the body

Physical Exam Proptosis Ophthalmoplegia Conjunctival chemosis Decreased vision Elevated intraocular pressure Pain on eye movement Orbital pain and tenderness are present early. Dark red discoloration of the eyelids, chemosis, hyperemia of the conjunctiva Purulent nasal discharge may be present.

Lab Work CBC Blood Culture

Cat Scan

Management IV Antibiotics to cover S aureus, S pyogenes, S pneuomniae, H influenza, M catarrhalis Cephalosporins Unasyn +/- Clindamycin, Flagyl Surgical Drainage Optho ENT

Thank You