Name
CELLULITIS, PERIORBITAL & ORBITAL
DESCRIPTION
DETAIL
CAUSES; . Cellulitis around the eye in adult . Staphylococcus aureus most common . Streptococcus pyogenes . Streptococcus pneumonia . Mixed infection . Cellulitis around the eye in children less than five years . H. influenzae most common -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS: β’ Retro-orbital cellulitis/abscess* CBC - LEUKOCYTOSIS WITH HIGH NEUTROPHILS * ESR - HIGH IF INFECTION β’ Aspiration of fluid from the orbit is contraindicated β’ Blood culture more likely to be positive in children < 5 years β’ Culture of discharge from nasal mucosa, nasopharynx and conjunctiva SPECIAL TESTS : Serial serological testing with antistreptolysin O, anti-deoxyribonuclease B, and anti-hyaluronidase tests may be successful in diagnosing cellulitis caused by group A, C, or G hemolytic streptococci IMAGING : β’ B-scan ultrasound β’ Plain orbital and sinus films β’ Computerized tomography (CT) is the most accurate and provides the most important information β’ Magnetic resonance imaging is the imaging modality of choice in diagnosing suspected cases of cavernous sinus thrombosis DIAGNOSTIC PROCEDURES: β’ Skin biopsy β’ Lumbar puncture should be considered for all children with H. influenzae type B cellulitis
TYPENOTES
RISK FACTORS: Trauma, Chronic sinusitis (anaerobic), Acute sinusitis (aerobic), Retained orbital foreign bodies, Puncture wound, Surgical procedure: Exploration of orbital tumor, retinal detachment procedure, strabismus operation, Bacteremia β’ AcutSURGICAL MEASURES : β’ Surgical debridement and/or drainage is needed if abscess develops or if clinical situation deteriorates despite adequate therapy in 24-48 hours or if visual acuity decreases β’ In orbital mucormycosis, surgical debridement of devitalized tissue is extremely important DRUG(S) OF CHOICE: β’ In adults, nafcillin or oxacillin 1.5 g every 4 hours β’ In children, ampicillin 200 mg/kg/day in divided doses intravenously plus nafcillin or oxacillin (100 g/kg/day) β’ Sinus decongestion - nasal sprays, oral decongestants, oral antihistamines ALTERNATIVE DRUGS : β’ In adults, cefotaxime or clindamycin or chloramphenicol or vancomycin β’ In children, if H. influenzae resistant to ampicillin - third generation cephalosporin, cefotaxime or chloramphenicol β’ In immunocompromised - piperacillin and gentamicin β’ Fluoroquinolones (adults) β’ Linezolid (Zyvox) PATIENT MONITORING: Repeat imaging in patients with orbital cellulitis PREVENTION/AVOIDANCE : β’ Avoid trauma β’ Avoid swimming in fresh water or salt water in the presence of skin abrasion β’ In H. influenzae cellulitis - rifampin prophylaxis for the entire family of an index case. Rifampin prophylaxis in day-care classroom in which one or two children exposed. Dosage - 20 mg/kg/24 h (maximum of 600 mg a day) for 4 days. POSSIBLE COMPLICATIONS : β’ Osteomyelitis β’ Strabismus β’ Afferent pupillary defect β’ Chronic draining sinus β’ Scarred upper eyelid β’ Profound visual loss β’ Blindness β’ Ophthalmoplegia β’ Cavernous sinus thrombosis β’ Meningitis β’ Intracranial abscess β’ Acute infarction of retina and choroid EXPECTED COURSE/PROGNOSIS : With adequate antibiotic treatment, outlook is good
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
ASLO TITER, BLOOD CULTURE, COMPLETE BLOOD COUNT, CSF EXAMINATION, PUS CULTURE TEST, MRI, CT SCAN, BIOPSY