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    A 4-year-old girl presented with swelling, warmth, and slight redness of her right eye that had been present for 2 days, accompanied by a 5-day fever. She had a previous upper airway infection treated 2 weeks earlier. Testing revealed an elevated CRP level. An orbital complication was suspected, so a CT scan showed a preseptal phlegmon in the right orbit with a subperiosteal abscess, in the context of pansinusitis. After surgical drainage and intravenous antibiotics, followed by oral antibiotics, she recovered fully over 3 days of treatment. Orbital cellulitis is a rare but dangerous infection that usually affects children and is often caused by sinusitis, potentially leading to

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    A 4-year-old girl presented with swelling, warmth, and slight redness of her right eye that had been present for 2 days, accompanied by a 5-day fever. She had a previous upper airway infection treated 2 weeks earlier. Testing revealed an elevated CRP level. An orbital complication was suspected, so a CT scan showed a preseptal phlegmon in the right orbit with a subperiosteal abscess, in the context of pansinusitis. After surgical drainage and intravenous antibiotics, followed by oral antibiotics, she recovered fully over 3 days of treatment. Orbital cellulitis is a rare but dangerous infection that usually affects children and is often caused by sinusitis, potentially leading to

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    11 views1 page

    Bachman

    Uploaded by

    otheas
    A 4-year-old girl presented with swelling, warmth, and slight redness of her right eye that had been present for 2 days, accompanied by a 5-day fever. She had a previous upper airway infection treated 2 weeks earlier. Testing revealed an elevated CRP level. An orbital complication was suspected, so a CT scan showed a preseptal phlegmon in the right orbit with a subperiosteal abscess, in the context of pansinusitis. After surgical drainage and intravenous antibiotics, followed by oral antibiotics, she recovered fully over 3 days of treatment. Orbital cellulitis is a rare but dangerous infection that usually affects children and is often caused by sinusitis, potentially leading to

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    of 1

    MEDICINE

    CLINICAL SNAPSHOT
    Visual Diagnosis of Orbital
    Cellulitis
    A 4-year-old girl presented with worsening swell-
    ing, overheating, and slight reddening of the right
    eye. This had had been present for 2 days and
    was accompanied by a fever which had been
    present for 5 days. Her clinical history included
    an infection of the upper airways accompanied
    by fever, which had been treated symptomatically
    2 weeks earlier. Laboratory testing revealed a
    CRP level of 86 mg/L. Slit-lamp examination find-
    ings were normal. An orbital complication was
    suspected, so an emergency unenhanced CT
    scan of the orbit and paranasal sinuses was per- a b
    formed. Imaging revealed a preseptal phleg-
    a) Reddening of the right eye with swelling of the eyelids, rhinorrhea, tenderness of the tragus, and right-
    monous change in the right orbit with a narrow side cervical lymphadenopathy. b) Unenhanced CT using soft tissue window, showing right orbit with
    subperiosteal abscess in an intraorbital, medial medially emphasized preseptal swelling of the soft tissues and slight suppression of the medial extracon-
    location, in the context of pansinusitis. After sur- al soft tissues, just reaching the posterior ethmoidal cells (arrow)
    gical removal and opening of the ethmoidal cells,
    intravenous ampicillin/sulbactam therapy was
    initiated, followed by oral cefpodoxime for 14 days. The girl was able to open her eyes again on the third day of inpatient treatment. Recovery was
    complete. Orbital cellulitis is a dangerous, rare, swiftly progressing disease that usually occurs in children, including small children. It is often
    caused by sinusitis or ethmoiditis and can more rarely be caused by an infected chalazion/stye, odontogenic tissue, intraorbital foreign bodies,
    periorbital skin trauma, or dacryocystitis. The main clinical signs are chemosis, conjunctival hyperemia, pain, swelling of the eyelids, exophthal-
    mos, eye motility problems, and diplopia/loss of vision. It entails the risk of cavernous sinus thrombosis, blindness, and sepsis.
    Sandy Bachmann, PD Dr. med. Jan De Laffolie, Prof. Dr. med. Klaus-Peter Zimmer, Abteilung für Allgemeine Pädiatrie und Neonatologie,
    Universitätsklinikum Gießen und Marburg GmbH, sandy.bachmann.93@gmail.com
    Conflict of interest statement: The authors declare that no conflict of interest exists.
    Translated from the original German by Christine Rye.
    Cite this as: Bachmann S, De Laffolie J, Zimmer KP: Visual diagnosis of orbital cellulitis. Dtsch Arztebl Int 2021; 118: 864. DOI: 10.3238/arztebl.m2021.0084.

    864 Deutsches Ärzteblatt International | Dtsch Arztebl Int 2021; 118

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