Here’s Dr. Alsup with today’s Morning Report!
Eye Infections
Orbital septum
-Connective tissue extension of the orbital periosteum
-Extends into the upper and lower eyelids
Periorbital / Preseptal
- Average age: 2 yo
- Result of local trauma, including insect bites
- Spread from contiguous structures, as in conjunctivitis, hordeolum, lacrimal system infections, and impetigo
- Associated with periorbital edema
Orbital
- Usually an extension of a sinus infection into the orbit behind the septum
- Average age of presentation is 12 years old
- Infections secondary to hematogenous spread during bacteremia due to nasopharyngeal pathogens
- Sinusitis, dental trauma
- Complications include sub-periosteal abscess, orbital abscess, cavernous sinusthrombosis, panophthalmitis, or endophthalmitis.
Microbiology
- S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus, S. pyogenes, and anaerobic upper respiratory flora such as Bacteroides and Fusobacterium species.
To CT or not?
- Painful eye movements
- Inability to perform a full evaluation of the eye due to edema
- Proptosis
- Ophthalmoplegia
- Decreased visual acuity or color vision
- Bilateral periorbital edema
DX:
- Plain radiographs—- crap
- CT orbit
- Ultrasound?
Dispo:
- Preseptal- most go home, unless unresponsive to po abx
- Orbital- admission!
Abx:
Cefuroxime or Ampicillin-sulbactam +/- Clindamycin and Vanco
References:
- I-Ting Preseptal and Orbital Cellulitis: A 10-Year Review of Hospitalized Patients. J Chin Med Assoc • September 2006 • Vol 69 • No 9
- http://emedicine.medscape.com/article/798397-overview
- Bedside ultrasound in the diagnosis of orbital cellulitis and orbital abscessCharlotte Derr, Ankit Shah. Emergency Radiology. June 2012, Volume 19, Issue 3, pp 265-267
- Tintinalli’s Emergency Medicine Chapter 115
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD
Editor in Chief of "The Original Kings of County"
Assistant Professor of Emergency Medicine
Assistant Residency Director
SUNY Downstate / Kings County Hospital
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