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

2. Swollen Eye Differential Diagnosis Noninfectious 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

6. 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 Hematogenous dissemination
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