Periorbital & orbital cellulitis

• What is orbital cellulitis?

  Infection of structures behind orbital septum (membranous sheet that forms anterior border or orbit, extends from orbital time & into eyelids)

  Sight- & life-threatening emergency
• What is periorbital (preseptal) cellulitis?

  Infection of tissue anterior to orbital septum

  More common & less severe than orbital cellulitis
• What are the RFs of periorbital & orbital cellulitis?

  Trauma

  Surgery -> ocular, adnexal or sinus

  Sinus disease (e.g. ethmoidal sinusitis - most common site of infection that spreads to orbit)

  Other facial infections (preseptal, dental abscess or dacryocystitis (infection of lacrimal sac))
• What are the signs & symptoms of orbital cellulitis?

  Periocular pain & swelling

  Fever

  Malaise

  Erythematous, swollen & tender eyelid

  Chemosis (swelling of conjunctiva)

  Proptosis

  Restricted eye movements ± diplopia

  
• What findings suggest periorbital cellulitis over orbital cellulitis?

  No proptosis

  Normal eye movements

  No chemosis

  Normal optic nerve function
• What are the Inx for periorbital & orbital cellulitis?

  Obs

  Full Hx & examination

  Swabs -> sent for microscopy, culture & sensitivity

  Bloods (FBC, CRP)

  CT orbit (gold standard to distinguish orbital from periorbital cellulitis)
• What is the management of orbital cellulitis?

  IV Abx

  Close monitoring

  Input from ophthalmology & ENT
• What is the management of periorbital cellulitis?

  Young/systemically unwell child

  • IV Abx

  Well child

  • PO Abx
  • Daily outpatient review
• What are the DDx of periorbital & orbital cellulitis?

  Orbital pseudo-tumour

  Thyroid eye disease

  Panophthalmitis
• What are the possible complications of periorbital & orbital cellulitis?

  Abscess

  Meningitis

  Ocular compartment syndrome

  Death