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