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Periorbital and Orbital Infections Morning Report 7/10/09.

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Presentation on theme: "Periorbital and Orbital Infections Morning Report 7/10/09."— Presentation transcript:

1 Periorbital and Orbital Infections Morning Report 7/10/09

2 Swollen Eye Differential Diagnosis – Noninfectious Causes – Infectious Causes Periorbital (Preseptal) Orbital

3 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

4 Noninfectious Causes Cont. Local edema-hypoproteinemia and congestive heart failure – Bilateral – Boggy – Nontender – Nondiscolored Allergic inflammation – Contact hypersensitivity – Angioneurotic edema

5 Anatomy


7 “Preseptal Cellulitis” Local infections – Conjunctivitis – Hordeolum – Chalazion – Dacryoadenitis – Dacryocystitis – Bacterial Cellulitis (trauma) Hematogenous dissemination – Bacterial periorbital cellulitis Acute Sinusitis-inflammatory edema

8 “Orbital Cellulitis” Acute Sinusitis – Subperiosteal Abscess – Orbital Abscess – Orbital Cellulitis – Cavernous Sinus Thrombosis Hematogenous dissemination Traumatic inoculation

9 Symptoms Eye Pain with movement or Restricted eye movement Painful swelling of upper and lower lids Proptosis Decreased Visual Acuity Fever Ill appearing

10 History Recent sinusitis or upper respiratory tract infection Fever or malaise Recent facial trauma or surgery, dental work Infection elsewhere in the body

11 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.

12 Lab Work CBC Blood Culture

13 Cat Scan


15 Management IV Antibiotics to cover S aureus, S pyogenes, S pneuomniae, H influenza, M catarrhalis – Cephalosporins – Unasyn – +/- Clindamycin, Flagyl Surgical Drainage – Optho – ENT

16 Thank You

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