Periorbital and Orbital Infections

Morning Report 7/10/09

Swollen Eye

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.

• Local edema-hypoproteinemia and congestive heart failure– Bilateral– Boggy– Nontender– Nondiscolored

• Allergic inflammation– Contact hypersensitivity – Angioneurotic edema

Anatomy

Anatomy

“Preseptal Cellulitis”• Local infections– Conjunctivitis– Hordeolum– Chalazion– Dacryoadenitis– Dacryocystitis– Bacterial Cellulitis (trauma)

• Hematogenous dissemination– Bacterial periorbital cellulitis

• Acute Sinusitis-inflammatory edema

“Orbital Cellulitis”

• Acute Sinusitis– Subperiosteal Abscess– Orbital Abscess– Orbital Cellulitis– Cavernous Sinus Thrombosis

• Hematogenous dissemination• Traumatic inoculation

Symptoms

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

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• 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.

Lab Work

• CBC• Blood Culture

Cat Scan

Management

• IV Antibiotics to cover S aureus, S pyogenes, S pneuomniae, H influenza, M catarrhalis– Cephalosporins– Unasyn– +/- Clindamycin, Flagyl

• Surgical Drainage– Optho– ENT

Thank You