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Orbital cellulitis (Clinical
presentation (Red eye
orbital cell,…
Orbital cellulitis
Clinical
presentation
Red eye
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Diagnosis
Examination
External eye examination
Lid swelling, proptosis, chemosis
CN examination
Reduced acuity, reduced colour vision,
reduced movements, RAPD
Investigations
Bloods
FBC, CRP, U+E, LFTs,
blood cultures
Imaging
URGENT CT head (abscessm diffuse infiltrate, proptosis)
Bedside
Obs (fever, sepsis)
ECG (tachycardic)
History
DH
Current meds, allergies (abx)
PMH
Sinusitis, ENT problems,
ocular problems, immunosuppressed,
Previous maxfax/ENT.ocular surgery
PC/HPC
Swollen red eye, pain,fever,
bulging eye, reduced movements,
previous URT infection (e.g. sinusitis)
SH
Occupation, smoking, alcohol
Management
Conservative
URGENT admission
Referral to ENT and ophthalmology
Mark extent of skin inflammation (monitoring)
Regular review (vision and eye movements)
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Surgical
I+D
Indication: pressure symptoms
MOA: removes inflammation, reduces
pressure on surrounding structures e.g optic nerve
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Aetiology
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Surgery
Orbital, lacrimal, vitreoretinal
Infection/inflammation
Sinusitis (ethmoid, maxillary)
Preseptal/facial infraction
Dental abscess
Pathophysiology
Mechanism
Spread from local source e.g. sinusitis
Can spread to cavernous sinus, causing meningitis, sepsis
Complications from inflammation in a confined space e.g. optic nerve compression, reducing acuity and colour vision,
and other cranial nerves reducing movement
Agent
S pneumonae, S aureus, S pyogenes, HiB
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