63 M complaining of erythema and pain to right side of his face for 3-4 days after being scratched by some metal. Right eye swollen shut with erythema and tenderness surrounding.
Orbital Cellulitis v. Preseptal Cellulitis
1. Preseptal Cellulitis (also known as Periorbital) – infection of soft tissue anterior to orbital septum (DOES NOT involve the orbit or other ocular structures)
Presentation: ocular pain, eyelid swelling and erythema (not unlike Orbital cellulitis).
No pain on eye movement, proptosis and opthalmoplegia with diplopia
Chemosis (conjunctival swelling) in severe cases (more common with orbital)
2. Orbital Cellulitis – infection involving contents of the orbit (fat and ocular muscles) but NOT THE GLOBE
Presents with: eye movement, proptosis and opthalmoplegia with diplopia, Chemosis, visual impairment
Pathogenesis– bacterial rhinosinusitis complication (most common cause), ophthalmic surgery, orbital trauma, dacryocystitis, infection of teeth, middle ear or face..
Diagnosis: based on history (hx of trauma locally or inset bite..) and exam – if convinced its preseptal stop there
- CT (only way to diagnose orbital cellulitis)- CT with contrast of the orbits and sinues. Orbital cellulitis with show proptosis, fat stranding around orbital contents and edema of extraocular muscle.
Treatment: need to cover for MRSA these days
- Preseptal- Clinda Monotherapy or TMP-SMX Plus Amox/Augmentin/Cefpodozime for 7-10 days
- Orbital- Uncomplicated can be treated with antibiotics alone broad spectrum with MRSA coverage tually switch to oral regiment for discharge)
Vancomycin + Ceftriaxone/Cefotaxime/Augmentin/Zosyn
Suspected intracranial extension cover for anaerboes (Ceftriaxone, Cefotaxime, Metronidazole)