Orbital Cellulitis

Orbital Cellulitis
SYMPTOMS Eye pain/tenderness, blurry vision, headache/pressure, fever, tooth pain
SIGNS Red and swollen eyelid, EOM restriction, proptosis, pain on eye movement, possible APD if there is optic nerve involvement
WORK-UP Thorough history: Ask about trauma, surgery, sinus/systemic/tooth infection, immunosuppression, and neck stiffness.
Thorough ocular examination: Check for EOM restrictions, proptosis, IOP, optic nerve evaluation, lymphadenopathy, and APD.
TREATMENT Refer to hospital/ER STAT
Hospitalization for IV antibiotics (broad spectrum). Penicillin derivatives If MRSA is suspected add vancomycin Cephalosporin consideration in the case of penicillin allergy, although there is a potential risk of cross-allergy Fluoroquinolone consideration in the case of cephalosporin allergy
Oral medication (after improvement with IV meds): Augmentin 875 mg bid (adults) Cefpodoxime 200 mg bid (adults) If MRSA is suspected consider doxycycline 100 mg bid or bactrim 160/800 bid
Consider antibiotic ung for corneal exposure
FOLLOW-UP 1-2x/day during hospitalization, every few days as an outpatient
ADDITIONAL LAB | TESTS CT of orbits and paranasal sinuses, CBC with differential and blood cultures
ETIOLOGY Orbital trauma, spread of infection from adjacent tissue, surgery sequela.
Many different microorganism species may cause orbital cellulitis.
DIFFERENTIAL DX Inflammatory disease (ex. sarcoidosis), Neoplasia (ex. leukemia, rhabdomyosarcoma), Trauma (ex. retrobulbar hemorrhage), Systemic diseases (ex. sickle cell disease), Endocrine disorders (ex. thyroid ophthalmopathy)
NOTES Orbital cellulitis is an ocular emergency. Patients may die due to a cavernous sinus thrombosis.
Renal insufficiency or failure may warrant a change in antibiotic dosing.
Corticosteroid use remains controversial.
Orbital cellulitis CT Scan