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

Diagnosis

1. Periorbital Cellulitis
   1. Swelling and erythema of tissues surrounding the orbit
   2. +/- pain with eye movement
   3. +/- fever
2. Orbital Cellulitis
   1. All of the above plus:
      1. Proptosis
      2. Chemosis (conj. swelling)
      3. Globe displacement
      4. Limitation of eye movements
      5. Double vision
      6. 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