Periorbital & Orbital Cellulitis

Last updated 03.11.12

Definition

-  Bacterial infection causing cellulitis involving the periobital or intraorbital tissues

 

Features

-  Orbital = post-septal

-  Orbital cellulitis = surgical emergency

-  Mortality 1-2%

-  Vision loss 3-11%

-  Periorbital = preseptal

-  Periorbital much more common than orbital

-  Both more common in children

-  Visually may be difficult to DDx orbital from periorbital

 

Risk Factors

-  Sinusitis most common cause of orbital cellulitis

-  In 1-3% acute sinusitis --> orbital cellulites

-  Both Dx in 73-94% of cases

-  Less commonly ass w preseptal (periorbital)

-  Contiguous spread of infection most common cause of periorbital cellulitis

-  Eyelid path: dacrocystitis..

-  Trauma: fracture

-  Bites

-  Foreign bodies

-  Surgery

 

Associated S/S

-  Periorbital oedema & erythema

-  +/- Fever

-  Only in orbital cellulitis

-  Opthalmoplegia

-  Proptosis

-  Globe displacement

-  Diplopia

-  Vision loss

-  Pain on eye movement

-  More common in orbital

-  Chemosis

-  Reduced visual acuity

-  Local tenderness

 

Periorbital

 

Orbital

 

 

Causes

-  Strep pyogenes

-  Strep pneumoniae

-  Staph aureus

-  Haemophilus Influenza Type B (Hib)

 

DDx

-  Allergic reaction

-  Absence of local or systemic signs (fever, tenderness)

 

Complications

-  Visual loss

-  Meningitis

-  Intracranial abscess

-  Septic cavernous sinus thrombosis

-  Abscess

-  Subperiosteal

-  Orbital

-  May lead to central retinal artery occlusion

 

Ix

-  FBE, CRP

-  BC

-  Higher yield in children

-  CT-Head (esp orbital & frontal regions)

-  Exclude trauma (blow out fractures)

-  Extension or inflam into orbit

-  Orbital or subperiosteal abscess

-  Indicated if

-  Severe disease

-  Poor response to Abx by 24hrs

-  Difficulty in assessing vision

-  CNS involvement

-  +/- LP

-  Contraindicated until CT-Head even if no neurology

-  If clinically indicated

 

Mx

-  Orbital Cellulitis

-  Cefotaxime 50mg/kg (max 2g) IV 6/24

-  Flucloxacillin 50mg/kg (max 2g) IV 6/24

-  ENT & Opthal R/V

-  +/- Surgical drainage

-  Periorbital Cellulitis

-  7-10/7 Abx

-  Mild

-  Out-pt Mx unless <1yrs

-  Augmentin (400/57mg per 5ml) 0.3ml/kg PO 12/24

-  If not improved by 24hrs --> admit, IV Abx, CT

-  Moderate

-  Flucloxacillin 50mg/kg (max 2g) IV 6/24

-  Severe or <5yrs or not immunized against Hib

-  Cefotaxime 50mg/kg (max 2g) IV 6/24

-  Flucloxacillin 50mg/kg (max 2g) IV 6/24

-  Failure to respond to Abx in 24-48hrs may inficate orbital cellulites

-  When improving change to Augmentin 25mg/kg (max 500mg) PO 8/24 7/7

-  If Hib: Rifampicin prophylaxis for meningitis

-  +/- Surgical drainage

 

 

RCH CPG

 

 

 

Reference

 

RCH CPG: Periorbital & Orbital Cellulitis 2011

Upto Date – Preseptal & Orbital Cellulitis

Pic (Orbital cellulitis)