Orbit SEQs

The Orbit


Preseptal Cellulitis

• infection of soft tissue anterior to orbital septum

Etiology
• usually follows periorbital trauma or dermal infection

Clinical Features
• tender, swollen and erythematous lids
• may have low-grade fever
• normal visual acuity, pupils, extraocular movements (EOM)
• no exophthalmos or RAPD

Treatment
• systemic antibiotics (Suspect H. influenza in children; S. aureus or Streptococci in adults)
• warm compresses


Orbital Cellulitis

• inflammation of orbital contents posterior to orbital septum
• common in children, but also in the aged and immunocompromised

Etiology
• usually secondary to sinus/facial/tooth infections or trauma

Clinical Features
• decreased visual acuity, pain, red eye, headache, fever
• lid erythema, tenderness, and edema with difficulty opening
• conjunctival injection and chemosis (conjunctival edema)
• proptosis, limitation of ocular movements (ophthalmoplegia) and pain with
movement
• RAPD, optic disc swelling

Treatment
• admit, IV antibiotics, blood cultures, orbital CT
• surgical drainage of abscess
• follow closely

Complications
• orbital apex syndrome, cavernous sinus thrombosis, meningitis, blindness

Finding Preseptal Cellulitis Orbital Cellulitis
Fever May be present Present
Lid edema Moderate to severe Severe
Chemosis Absent or mild Moderate or marked
Proptosis Absent Present
Pain on eye movement Absent Present
Ocular mobility Normal Decreased
Vision Normal Diminished ± diplopia
RAPD Absent May be seen
Leukocytosis Minimal or moderate Marked
ESR Normal or elevated Elevated
Additional findings Skin infection Sinusitis, dental abscess