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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 - PowerPoint PPT Presentation
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Periorbital and Orbital Infections
Morning Report 7/10/09
Swollen Eye
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
Noninfectious Causes Cont.
• Local edema-hypoproteinemia and congestive heart failure– Bilateral– Boggy– Nontender– Nondiscolored
• Allergic inflammation– Contact hypersensitivity – Angioneurotic edema
Anatomy
Anatomy
“Preseptal Cellulitis”• Local infections– Conjunctivitis– Hordeolum– Chalazion– Dacryoadenitis– Dacryocystitis– Bacterial Cellulitis (trauma)
• Hematogenous dissemination– Bacterial periorbital cellulitis
• Acute Sinusitis-inflammatory edema
“Orbital Cellulitis”
• Acute Sinusitis– Subperiosteal Abscess– Orbital Abscess– Orbital Cellulitis– Cavernous Sinus Thrombosis
• Hematogenous dissemination• Traumatic inoculation
Symptoms
• Eye Pain with movement or • Restricted eye movement• Painful swelling of upper and lower lids• Proptosis• Decreased Visual Acuity• Fever • Ill appearing
History
• Recent sinusitis or upper respiratory tract infection
• Fever or malaise• Recent facial trauma or surgery, dental work• Infection elsewhere in the body
Physical Exam• Proptosis• Ophthalmoplegia• Conjunctival chemosis • 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.
Lab Work
• CBC• Blood Culture
Cat Scan
Management
• IV Antibiotics to cover S aureus, S pyogenes, S pneuomniae, H influenza, M catarrhalis– Cephalosporins– Unasyn– +/- Clindamycin, Flagyl
• Surgical Drainage– Optho– ENT
Thank You