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Periorbital and Orbital Infections

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

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  1. Periorbital and Orbital Infections Morning Report 7/10/09

  2. Swollen Eye • Differential Diagnosis • Noninfectious Causes • Infectious Causes • Periorbital (Preseptal) • Orbital

  3. 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

  4. Noninfectious Causes Cont. • Local edema-hypoproteinemia and congestive heart failure • Bilateral • Boggy • Nontender • Nondiscolored • Allergic inflammation • Contact hypersensitivity • Angioneurotic edema

  5. Anatomy

  6. Anatomy

  7. “PreseptalCellulitis” • Local infections • Conjunctivitis • Hordeolum • Chalazion • Dacryoadenitis • Dacryocystitis • Bacterial Cellulitis (trauma) • Hematogenous dissemination • Bacterial periorbitalcellulitis • Acute Sinusitis-inflammatory edema

  8. “Orbital Cellulitis” • Acute Sinusitis • Subperiosteal Abscess • Orbital Abscess • Orbital Cellulitis • Cavernous Sinus Thrombosis • Hematogenous dissemination • Traumatic inoculation

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

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

  11. 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.

  12. Lab Work • CBC • Blood Culture

  13. Cat Scan

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

  15. Thank You

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