Periorbital and Orbital Infections

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Periorbital and Orbital Infections

• Morning Report
• 7/10/09

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Swollen Eye

• Differential Diagnosis
• Noninfectious Causes
• Infectious Causes
• Periorbital (Preseptal)
• Orbital

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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

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Noninfectious Causes Cont.

• Local edema-hypoproteinemia and congestive heart
  failure
• Bilateral
• Boggy
• Nontender
• Nondiscolored
• Allergic inflammation
• Contact hypersensitivity
• Angioneurotic edema

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Anatomy
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Anatomy
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Preseptal Cellulitis

• Local infections
• Conjunctivitis
• Hordeolum
• Chalazion
• Dacryoadenitis
• Dacryocystitis
• Bacterial Cellulitis (trauma)
• Hematogenous dissemination
• Bacterial periorbital cellulitis
• Acute Sinusitis-inflammatory edema

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Orbital Cellulitis

• Acute Sinusitis
• Subperiosteal Abscess
• Orbital Abscess
• Orbital Cellulitis
• Cavernous Sinus Thrombosis
• Hematogenous dissemination
• Traumatic inoculation

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Symptoms

• Eye Pain with movement or
• Restricted eye movement
• Painful swelling of upper and lower lids
• Proptosis
• Decreased Visual Acuity
• Fever
• Ill appearing

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History

• Recent sinusitis or upper respiratory tract
  infection
• Fever or malaise
• Recent facial trauma or surgery, dental work
• Infection elsewhere in the body

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Physical Exam

• Proptosis
• Ophthalmoplegia
• Conjunctival chemosis
• 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.

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Lab Work

• CBC
• Blood Culture

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Cat Scan
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Management

• IV Antibiotics to cover S aureus, S pyogenes, S
  pneuomniae, H influenza, M catarrhalis
• Cephalosporins
• Unasyn
• /- Clindamycin, Flagyl
• Surgical Drainage
• Optho
• ENT

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Thank You