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| ===Background===
| | #REDIRECT[[Orbital cellulitis]] |
| *Must 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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| ==ORBITAL CELLULITIS (vs. Periorbital)==
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| Any of the following:
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| # Fever
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| # Ill appearance
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| # Blurred vision
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| # Proptosis
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| # Painful/limited EOM
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| # Diplopia
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| # Edema of optic disk
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| # Venous engorgement of retina
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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 | |
| ##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
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| ## 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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| ==Disposition==
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| *Periorbital Cellulitis
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| **If well-appearing and afebrile consider discharge
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| **If concern of hematogenous cause consider admission
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| *Orbital Cellulitis
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| **Admit
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| ==See Also==
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| [[Periorbital Swelling]]
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| ==Source==
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| UpToDate
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| Tintinalli
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| [[Category:ID]]
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| [[Category:Ophtho]]
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