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    Periorbital Cellulitis

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    Nurliyana Ghazali
    Periorbital cellulitis is an infection around the eye that can spread deeper. It is caused by bacteria like Staphylococcus aureus, Streptococcus pneumoniae, or Haemophilus influenzae. Clinical features include eyelid swelling, redness, and fever. CT scan and lumbar puncture are used to assess spread. Prompt treatment with intravenous antibiotics is needed to prevent complications like orbital cellulitis, cavernous sinus thrombosis, or meningitis.

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    Periorbital Cellulitis

    Uploaded by

    Nurliyana Ghazali
    108 views2 pages
    Periorbital cellulitis is an infection around the eye that can spread deeper. It is caused by bacteria like Staphylococcus aureus, Streptococcus pneumoniae, or Haemophilus influenzae. Clinical features include eyelid swelling, redness, and fever. CT scan and lumbar puncture are used to assess spread. Prompt treatment with intravenous antibiotics is needed to prevent complications like orbital cellulitis, cavernous sinus thrombosis, or meningitis.

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    Periorbital cellulitis

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    Periorbital cellulitis is an infection around the eye that can spread deeper. It is caused by bacteria like Staphylococcus aureus, Streptococcus pneumoniae, or Haemophilus influenzae. Clinical features include eyelid swelling, redness, and fever. CT scan and lumbar puncture are used to assess spread. Prompt treatment with intravenous antibiotics is needed to prevent complications like orbital cellulitis, cavernous sinus thrombosis, or meningitis.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    108 views2 pages

    Periorbital Cellulitis

    Uploaded by

    Nurliyana Ghazali
    Periorbital cellulitis is an infection around the eye that can spread deeper. It is caused by bacteria like Staphylococcus aureus, Streptococcus pneumoniae, or Haemophilus influenzae. Clinical features include eyelid swelling, redness, and fever. CT scan and lumbar puncture are used to assess spread. Prompt treatment with intravenous antibiotics is needed to prevent complications like orbital cellulitis, cavernous sinus thrombosis, or meningitis.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
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    Periorbital cellulitis

    - Anatomy
    o The orbital septum is a fibrous membrane that extends from the periosteum of the
    orbit as the arcus marginalis and lies just deep to the orbicularis oculi muscle. In the
    upper lids, the septum fuses with the levator aponeurosis. In the lower lids, the
    septum fuses with the capsulopalpebral fascia.1 The orbital septum acts as a physical
    barrier to the spread of infection

    - Pathology
    o In non-immunosed, young patient usually haemophilus influenza b usually after local
    trauma to the skin including insect bites
    o Should keep in mind that this bug can cause other infection e.g meningitis
     Should exclude meningism
    o In older ppl, spread of infection from paranasal sinusitis or dental abscess

    - When associated with trauma


    o Staphylococcus aureus: This may include methicillin-resistant Staphylococcus
    aureus18 and treatment should be tailored to local incidence of infection . 
    o Streptococcus pyogenes (group A streptococci)
    - In the absence of trauma
    o Streptococcus pneumoniae
    o H influenzae type b was the predominant cause prior to the advent of the Hib vaccine
    but has now only been shown to cause rare cases.8,19,20,21

    - Clinical features: -
    o Fever, erythema, tenderness and oedema of eyelids
    o Almost always unilateral
    - Investigations
    o CT scan to assess if there is posterior spread
    o Lumbar puncture – to exclude meningitis
    - Should be treated promptly
    o Why to prevent spread to posterior spread –orbital cellulitis
     Proptosis
     Painful ocular movement
     Reduced visual acuity
    Management

    Preseptal cellulitis
    12,6

     Adults: 250(qds) - 500(tds)mg oral co-amoxiclav depending on severity of infection, for 10


    days with daily review until there is definite improvement (then every 2-7 days until
    complete recovery).5
     Children: 20-40mg/kg/day oral co-amoxiclav over 24h in three divided doses.
     Lid abscesses should be drained.9

    Orbital cellulitis
     Hospital admission under the joint care of the ophthalmologists and the ENT surgeons is
    mandatory.3 (Prior to the advent of antibiotics, orbital cellulitis had a mortality rate of
    17% and 20% of the survivors were blind in the affected eye. 1)
     These patients will have a full set of investigations (see above).
     Intramuscular - or more commonly - intravenous antibiotics are used (e.g. ceftriaxone 1-
    4gm daily with 1-2gm flucloxacillin qds) in addition to metronidazole in patients over 10
    years old with chronic sinonasal disease.5
     Clindamycin plus a quinolone such as ciprofloxacin are used where there is penicillin
    sensitivity.13Vancomycin is also an alternative.
     Optic nerve function is monitored every 4 hours (pupillary reactions, visual acuity, colour
    vision and light brightness appreciation).
     Treatment may be modified according to microbiology results and lasts for 7-10 days. 13
     Surgery is indicated where there is CT evidence of an orbital collection, where there is no
    response to antibiotic treatment, where visual acuity decreases and where there is an
    atypical picture which may warrant a diagnostic biopsy. Surgery often concurrently
    warrants drainage of infected sinuses. 6

    Complications

    - Orbital cellulitis
    - Cavernous sinus thrombosis
    - Meningitis

    Differential diagnosis

     Orbital pseudotumor, who are usually complaining only of eye pain.


     Angioedema
     Insect bites
     Nephrotic syndrome
     Orbital cellulitis

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