Orbital Cellulitis

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CLINICAL DESCRIPTION

This is an ophthalmic emergency. Risk factors include sinus disease, traumatic orbital septal perforation and post orbital surgery. 

CLINICAL FEATURES

SIGNS AND SYMPTOMS

  • Fever, periocular pain, inflamed eye lids, proptosis, restricted and painful extraocular movements, poor visual acuity, RAPD, reduced color vision

INVESTIGATIONS

  • FBC, BC, CSF analysis if meningeal or cerebral signs develop
  • CT scan of the orbits, paranasal sinuses and brain

TREATMENT

  • Hospital admission
  • ENT assessment is mandatory.
  • Antimicrobial therapy
    • Ceftazidime 1g IV 8hourly and Metronidazole 500mg IV 8hourly. Therapy should be continued until the patient is apyrexial for 4 days.
  • Optic nerve function monitoring
    • Visual acuity, colour vision, pupillary reactions, and light brightness appreciation.
  • Surgical intervention should be considered in orbital or subperiosteal abscesses, unresponsiveness to antibiotics and in decreasing vision.