PERIORBITAL CELLULITISPERIORBITAL CELLULITIS

Karen R Brungard MD

CELLULITISCELLULITIS

PRESEPTAL

OR ORBITAL

OBJECTIVESOBJECTIVES

Define preseptal and orbital cellulitis

Review complications

Discuss workup and treatment options

ImitatorsImitators

DEFINITIONDEFINITION

PRESEPTAL CELLULITIS is an infection of the soft tissue of the eyelids and periorbital structures anterior to the orbital septum

ORBITAL CELLULITIS is an infection of the orbital soft tissue posterior to the orbital septum

ORBITAL SEPTUMORBITAL SEPTUM The orbital septum is a

layer of fascia extending vertically from the periosteum of the orbital rim to the leavator aponeurosis of the upper lid and to the tarsal plate of the lower lid.

Orbital AnatomyOrbital Anatomy

PATHOGENISISPATHOGENISIS

Localized eyelid infection– Hordolea, chalazia, dacryocystitis

Trauma

Dental

Sinusitis

ANATOMYANATOMY

Orbital AnatomyOrbital Anatomy

AnatomyAnatomy

AnatomyAnatomy

Complications of Orbital Complications of Orbital CellulitisCellulitis

Intracranial 4% Meningitis 2% Cavernous sinus thrombosis 1% Brain, Subdural and Epidural abscess 1% Orbital abscess 9% Subperiosteal abscess 7% Orbital abscess 2% Vision loss 1%

Classification Description

Group 1 Preseptal Erythema & edema of eyelids, normal vision

Group 2 Orbital cellulits Diffuse edema of orbit,

No abscess

Group 3 Orbital cellulitis with

subperiostal abscess

Abscess adjacent to lamina papyracea, proptosis, change in vision, pain on eye movement

Group 4 Orbital cellulitis with abscess in orbital fat

Proptosis, limited mobility, loss of vision

Group 5 Cavernous sinus thrombosis

Bilateral disease

COMPARISONCOMPARISONFeatures Orbital Cellulitis Preseptal Cellulitis

Proptosis Yes No

Motility Limited No

Vision Decreased No

Chemosis Yes Infrequent

Source Sinusitis U.R.I.

Preseptal Cellulitis

ORBITAL CELLULITISORBITAL CELLULITIS

Proptosis &ChemosisProptosis &Chemosis

MotilityMotility

Strep & Staph

H Flu

M. catarrhalis

Anaerobes

MRSA

Aerobic S aureus

S pneumoniae

H influenza

M catarrhalis

Enterobactiacea

P aeruginosa

4% 14%

31 6

21 5

8 6

7 6

2 3

15% 24%

35 6

27 6

8 -

- 47

- 6

- 15%

33 -

40 15

20 15

- 8

- 8

56% 14%

6 -

12 14

-

- 28

6 14

Anaerobic

Peptostreptoccus

P acnes

Fusobacterium

Prevotella

B fragilis

2 56

- 29

2 17

2 47

6

15 59

12 18

4 47

8 82

- -

3 38

3 8

3 31

62 6

- 15

19 57

12 29

6 54

6 86

- -

Maxillary Ethmoid Frontal Sphenoid

Acute chronicAcute chronic Acute chronic Acute chronic

ORBITAL CELLULITISORBITAL CELLULITIS

TREATMENT IV UNASYNTREATMENT IV UNASYN