Orbital cellulitis

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Is a sudden acute inflammation of the tissues around the eye

Causes

  • Children: most common cause is post sinus infection by Haemophilus influenzae
  • Adults: common causes are Staphylococcus aureus, Streptococcus pneumoniae, and beta-haemolytic streptococcus, bacteroides species
  • Sinus infection, tooth extraction, orbital trauma may be the trigger

Signs and symptoms

  • Swollen eyelids, purulent nasal discharge may be present
  • Fever and headache
  • Pain in the eye especially on eye movement, decrease vision
  • Conjunctival chemosis and injection,
  • Proptosis

Differential diagnosis

  • Infection: cavernous sinus thrombosis
  • Endocrine dysfunction: dysthyroid exophthalmos
  • Idiopathic inflammation: orbital myositis, orbital pseudo tumour, Wegener’s granulomatosis
  • Neoplasm with inflammation, e.g. Burkitt’s lymphoma

Investigations

  • Full blood count, ESR
  • Blood culture
  • Assessment of purulent nasal discharge or from the abscess (swab for microscopy, culture and sensitivity)
  • CT Scan and MRI will help differentiate it from other diseases

Treatment objectives

  • Achieve normal body temperature
  • Treat infection
  • Relieve pain

Patient must be hospitalized

Non- pharmacological treatment

  • Adequate hydration
  • Other supportive care measures

Pharmacological treatment

Ampicillin/cloxacillin

Adult:

1g IV stat then 500mg 6hrly for 2 weeks

Child

> 1month old: 50mg/kg IV 8hrly for 7-14days

≤ 1 month old: 25-50mg/kg, IV 8hrly for 7-14days

PLUS

Gentamicin IV

Adult

160mg once a day for 7days

Child

 > 1 month old: 7.5mg/kg IV, once a day for 5-7days

≤ 1-month-old: 5mg/kg, once a day for 5-7days

PLUS

Metronidazole

Adult:

500mg IV 8hrly for 7 days

Child:

> 1 month old: 7.5-15mg/kg 6hrly for 7-10days

PLUS

Analgesic/non-steroidal anti-inflammatory medicines

Ibuprofen oral

Adult:

400mg-800mg 6-8hrly, not to exceed 3.2g/day

Child:

30-40mg/kg per day in 3-4 doses

OR

Paracetamol

Adult:

1g 4-6hrly to a maximum of 4 doses per 24 hours, for 3days

Child:

10-14mg/kg for 3 days

Note: Do not use ibuprofen in patients with bleeding disorders or peptic ulcers

Refer to Ophthalmologist for specialist care