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| ===Background===
| | #REDIRECT[[Orbital cellulitis]] |
| * Important to distinguish between these two conditions
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| * Orbital cellulitis may mimic periorbital cellulitis early in its course!
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| * Orbital cellulitis most often 2/2 ethmoid sinusitis
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| * May also be 2/2 orbital trauma, endophthalmitis, infectious infection from teeth / middle ear
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| * Periorbital cellulitis most often 2/2 contiguous infection of soft tissues of face and eyelids
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| * Periorbital cellulitis does not lead to orbital cellulitis
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| ==Diagnosis==
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| ===Signs/Symptoms===
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| # Periorbital Cellulitis
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| ## Swelling and erythema of tissues surrounding the orbit
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| ## +/- pain with eye movement
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| ## +/- fever
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| # Orbital Cellulitis
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| ## All of the above plus:
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| ### Proptosis
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| ### Chemosis (conj. swelling)
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| ### Globe displacement
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| ### Limitation of eye movements
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| ### Double vision
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| ### Vision loss (indicates orbital apex involvement)
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| ===Imaging===
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| # CT Orbit with IV contrast
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| ## Indicated for suspected orbital cellulitis or in pts who cannot accurately assess vision (e.g. age <1yr)
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| ## Findings c/w orbital cellulitis:
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| ### Proptosis
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| ### Inflammation of ocular muscles
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| ### Subperiosteal or orbital abscess
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| ==Complications==
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| # Subperiosteal Abscess
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| ## Must be distinguished from orbital cellulitis based on CT
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| # Orbital Abscess | |
| ## Pts tend to have severe proptosis, globe displacement, and appear systemically ill
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| ## May be clinically indistinguishable from orbital cellulitis; requires CT
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| # Meningitis
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| # Cavernous sinus thrombosis
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| ==Treatment==
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| # Periorbital Cellulitis
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| ## Most cases (except for pts < 1yr) can be managed as outpatient w/ oral abx and daily f/u
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| ## Treatment (7-10 days)
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| ### Augmentin 875mg BID OR
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| ### Cefpodoxime 200mg BID OR
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| ### Cefdinir 600mg qd
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| # Orbital Cellulitis
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| ## Vancomycin +
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| ### Ampicillin-sulbactam 3 g IV q6hr OR
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| ### Ticarcillin-clavulanate 3.1 g IV q4h OR
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| ### Piperacillin-tazobactam 4.5 g IV q6h OR
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| ### Ceftriaxone 2 g IV q12hr OR
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| ### Cefotaxime 2 g IV q4h
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| ==See Also==
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| Ophtho: Periorbital Swelling
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| ==Source==
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| UpToDate
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| [[Category:Ophtho]]
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