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