periorbital and orbital infections
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Periorbital and Orbital Infections. Morning Report 7/10/09. Swollen Eye. Differential Diagnosis Noninfectious Causes Infectious Causes Periorbital ( Preseptal ) Orbital. Noninfectious Causes. Blunt Trauma-increased swelling x48hrs then resolves over several days

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Presentation Transcript
swollen eye
Swollen Eye
  • Differential Diagnosis
    • Noninfectious Causes
    • Infectious Causes
      • Periorbital (Preseptal)
      • Orbital
noninfectious causes
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
Noninfectious Causes Cont.
  • Local edema-hypoproteinemia and congestive heart failure
    • Bilateral
    • Boggy
    • Nontender
    • Nondiscolored
  • Allergic inflammation
    • Contact hypersensitivity
    • Angioneurotic edema
preseptal cellulitis
“Preseptal Cellulitis”
  • Local infections
    • Conjunctivitis
    • Hordeolum
    • Chalazion
    • Dacryoadenitis
    • Dacryocystitis
    • Bacterial Cellulitis (trauma)
  • Hematogenous dissemination
    • Bacterial periorbitalcellulitis
  • Acute Sinusitis-inflammatory edema
orbital cellulitis
“Orbital Cellulitis”
  • Acute Sinusitis
    • Subperiosteal Abscess
    • Orbital Abscess
    • Orbital Cellulitis
    • Cavernous Sinus Thrombosis
  • Hematogenous dissemination
  • Traumatic inoculation
symptoms
Symptoms
  • Eye Pain with movement or
  • Restricted eye movement
  • Painful swelling of upper and lower lids
  • Proptosis
  • Decreased Visual Acuity
  • Fever
  • Ill appearing
history
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
Physical Exam
  • Proptosis
  • Ophthalmoplegia
  • Conjunctivalchemosis
  • 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
Lab Work
  • CBC
  • Blood Culture
management
Management
  • IV Antibiotics to cover S aureus, S pyogenes, S pneuomniae, H influenza, M catarrhalis
    • Cephalosporins
    • Unasyn
    • +/- Clindamycin, Flagyl
  • Surgical Drainage
    • Optho
    • ENT
ad