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Periorbital vs Orbital Cellulitis: Differentiating Features and Management Steps

This question examines the features on history and examination to distinguish between periorbital (pre-septal) cellulitis and orbital (post-septal) cellulitis in an 8-year-old boy. It also tests knowledge on specific management steps for orbital cellulitis with a periosteal abscess, including medication doses and fluid choices. Some common errors and misconceptions are highlighted. Good luck!

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Periorbital vs Orbital Cellulitis: Differentiating Features and Management Steps

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  1. Question 16 Simon Craig

  2. 8 year-old boy.

  3. Part 1 • Features on history and examination which can help distinguish periorbital (pre-septal) cellulitis from orbital (post-septal) cellulitis • 8 marks available • Easy question! • 6 is a “pass” for this

  4. Part 1 (8 marks)

  5. Part 1 • Also gave marks for RAPD • Less useful answers • “Fever” in both columns • Septic shock / meningitis (pretty uncommon!) • “Injected cornea”

  6. Part 2 • CT scan shows orbital cellulitis with large periosteal abscess • List 4 specific management steps

  7. Part 2 (4 marks)

  8. Part 2 • Done reasonably well, however….. • A number of people advocated for lateral canthotomy (guided by measurement of IOP) • Some “odd” antibiotic choices • Medication doses incorrect • Incorrect IV fluid choice • ICU admission

  9. A few “basics” • A drug with no dose is better than an incorrect dose • Children are dosed by the kg • Usual maintenance in kids is 0.9% NaCl + 5% glucose (not Normal saline)

  10. A few “basics” • Don’t say things that draw attention to yourself. • You will only frighten the examiner and draw attention to yourself! • An ED physician doing a lateral canthotomy in a child without trauma based on measurement of IOP is a little “out there”

  11. Good luck!

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