PERIORBITAL CELLULITIS

Karen R Brungard MD

CELLULITIS

PRESEPTAL OR ORBITAL

OBJECTIVES

Define preseptal and orbital cellulitis

Review complications Discuss workup and treatment options

Imitators

DEFINITION

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 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 Anatomy

PATHOGENISIS

Localized eyelid infection

Hordolea, chalazia, dacryocystitis

Trauma Dental Sinusitis

ANATOMY

Orbital Anatomy

Anatomy

Anatomy

Complications of Orbital Cellulitis

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 Group 1
Group 2 Group 3
Preseptal

Description
Erythema & edema of eyelids, normal vision Diffuse edema of orbit, No abscess Abscess adjacent to lamina papyracea, proptosis, change in vision, pain on eye movement Proptosis, limited mobility, loss of vision Bilateral disease

Orbital cellulits

Orbital cellulitis with subperiostal abscess

Group 4 Group 5

Orbital cellulitis with abscess in orbital fat Cavernous sinus thrombosis

COMPARISON
Features Proptosis Motility Vision Chemosis Source Orbital Cellulitis Yes Limited Decreased Yes Sinusitis Preseptal Cellulitis No No No Infrequent U.R.I.

Preseptal Cellulitis

ORBITAL CELLULITIS

Proptosis &Chemosis

Motility

M. catarrhalis

Strep & Staph

Anaerobes

H Flu
MRSA

Maxillary
Acute chronic

Ethmoid
Acute chronic Acute

Frontal
chronic

Sphenoid
Acute chronic

Aerobic
S aureus S pneumoniae H influenza M catarrhalis Enterobactiacea 4% 31 21 8 7 2 14% 6 5 6 6 3 15% 35 27 8 24% 6 6 47 6 33 40 20 15% 15 15 8 8 56% 6 12 6 14% 14
28 14

P aeruginosa
Anaerobic
Peptostreptoccus P acnes Fusobacterium Prevotella B fragilis

2 2 2

56 29 17 47 6

15 12 4 8 -

59 18 47 82 -

3 3 3 62 -

38 8 31 6 15

19 12 6 6 -

57 29 54 86 -

ORBITAL CELLULITIS

TREATMENT IV UNASYN