Orbital cellulitis
- patient: patients with siniusitis. Children.
- pathophysiology: infection of fat and extraocular muscles of eyes
- viridans strep, strep pneumo, staph aureus
- Sx:
- erythema, edema, and tenderness, often with impaired extraocular movement.
- Only orbital cellulitis involves the post-septal (ie, orbital) structures such as the extraocular muscles (ophthalmoplegia, painful eye movements) and orbital fat (proptosis).
- Dx: CT or MRI scan, look for abscess/purulence
- Rx: empiric IV abx third-generation cephalosporin (eg, ceftriaxone) or ampicillin-sulbactam (covers strep pneumo, viridans, H flu, staph aureus. For patients with a history of methicillin-resistant S aureus or whose clinical presentation is severe, vancomycin should be added.
Orbital cellulitis is more concerning and can be differentiated from the less serious, but more common, preseptal cellulitis by identifying signs or symptoms suggestive of intra-orbital inflammation.
Preseptal cellulitis
- patient:
- pathophysiology: Preseptal cellulitis may be secondary to sinusitis but more commonly is due to breaks in the skin. As a result, S aureus and S pyogenes are common causes of preseptal cellulitis.
- Sx: no painful eye movement
- Rx: oral abx