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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Periorbital and orbital infections

Periorbital and Orbital Infections

Morning Report

7/10/09


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