Ver el código de «Periorbital vs Orbital Cellulitis»

===Background===


* Important to distinguish between these two conditions
* Orbital cellulitis may mimic periorbital cellulitis early in its course! 
* Orbital cellulitis most often 2/2 ethmoid sinusitis
* May also be 2/2 orbital trauma, endophthalmitis, infectious infection from teeth / middle ear 
* Periorbital cellulitis most often 2/2 contiguous infection of soft tissues of face and eyelids
* Periorbital cellulitis does not lead to orbital cellulitis
===Signs/Symptoms ===


* Periorbital Cellulitis
* Swelling and erythema of tissues surrounding the orbit
* +/- pain with eye movement 
* +/- fever
* Orbital Cellulitis
* All of the above plus:
* Proptosis
* Chemosis (conj. swelling) 
* Globe displacement
* Limitation of eye movements
* Double vision
* Vision loss (indicates orbital apex involvement)
===Diagnosis===


* CT Orbit with IV contrast
* Indicated for suspected orbital cellulitis or in pts who cannot accurately assess vision (e.g. age <1yr)
* Findings c/w orbital cellulitis:
* Proptosis
* Inflammation of ocular muscles
* Subperiosteal or orbital abscess  
== ==


==Complications==


* Subperiosteal Abscess
* Must be distinguished from orbital cellulitis based on CT
* Orbital Abscess
* Pts tend to have severe proptosis, globe displacement, and appear systemically ill
* May be clinically indistinguishable from orbital cellulitis; requires CT 
* Meningitis
* Cavernous sinus thrombosis 
 

==Treatment==


* Periorbital Cellulitis
* Most cases (except for pts < 1yr) can be managed as outpatient w/ oral abx and daily f/u
* Treatment (7-10 days)
* Augmentin 875mg BID OR
* Cefpodoxime 200mg BID OR
* Cefdinir 600mg qd
* Orbital Cellulitis
* Vancomycin +
* Ampicillin-sulbactam 3 g IV q6hr OR
* Ticarcillin-clavulanate 3.1 g IV q4h OR
* Piperacillin-tazobactam 4.5 g IV q6h OR
* Ceftriaxone 2 g IV q12hr OR
* Cefotaxime 2 g IV q4h
See Also

Ophtho:  Periorbital Swelling

 

===Source: UpToDate===





[[Category:Ophtho]]