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| __NOTOC__ | | __NOTOC__ |
| | {{Orbital cellulitis}} |
| | {{CMG}}; {{AE}} [[User: Prashanthsaddala|Prashanth Saddala M.B.B.S]], {{TarekNafee}} |
| | <br>'''''Synonyms and Keywords:''''' Retroseptal cellulitis; Postseptal cellulitis; Retrobulbar cellulitis |
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| | '''For patient information, click [[Orbital cellulitis (patient information)|here]]''' |
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| == Overview == | | ==[[Orbital cellulitis overview|Overview]]== |
| '''Orbital cellulitis''' is a serious infection of the orbital tissues which can lead to restriction of eye movements, loss of vision and even loss of life. '''Orbital cellulitis''' is an inflammation of eye tissues posterior to the [[orbital septum]]. It most commonly refers to an acute spread of infection into the eye socket from either the adjacent sinuses or through the blood. When it affects the rear of the eye, it is known as retro-orbital cellulitis.
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| It should not be confused with [[periorbital cellulitis]], which refers to [[cellulitis]] anterior to the septum.
| | ==[[Orbital cellulitis historical perspective|Historical Perspective]]== |
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| ==Causes== | | ==[[Orbital cellulitis classification|Classification]]== |
| Orbital cellulitis occurs commonly from bacterial infection spread by the paranasal sinuses. Other ways in which orbital cellulitis may occur is from infection in the blood stream and from an eyelid skin infection. Upper respiratory infection, sinusitis, trauma to the eye, ocular or periocular infection and systemic infection all increase one’s risk of orbital cellulitis.
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| [[Staphylococcus aureus]], [[Streptococcus pneumoniae]] and beta-hemolytic streptococci are three bacteria that can be responsible for orbital cellulitis. | | ==[[Orbital cellulitis pathophysiology|Pathophysiology]]== |
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| * [[Staphylococcus aureus]], is a gram-positive bacterium which is the most common of staph infections. Staphylococcus aureus infection can spread to the orbit from the skin. Staph organisms are able to produce toxins which promote their virulence which leads to the inflammatory response seen in orbital cellulitis. Staphylococcus infections are identified by a cluster arrangement on gram stain. Staphylococcus aureus forms large yellow colonies (which is distinct from other Staph infections such as Staphylococcus epidermis which forms white colonies).
| | ==[[Orbital cellulitis causes|Causes]]== |
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| * [[Streptococcus pneumoniae]], is also a gram-positive bacterium responsible for orbital cellulitis due to its ability to infect the sinuses ([[sinusitis]]). Strep organisms are able to determine their own virulence and can invade surrounding tissues causing an inflammatory response seen in orbital cellulitis (similar to Staphyloccoccus aureus). Streptococcal infections are identified on culture by their formation of pairs or chains. Streptococcus pneumoniae produce green (alpha) hemolysis, or partial reduction of red blood cell hemoglobin.
| | ==[[Orbital cellulitis differential diagnosis|Differentiating Orbital cellulitis from other Diseases]]== |
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| == Diagnosis == | | ==[[Orbital cellulitis epidemiology and demographics|Epidemiology and Demographics]]== |
| Orbital cellulitis should be differentiated from preseptal cellulitis which is confined to structures anterior to orbital septum. Where as, orbital cellulitis involves structures posterior to orbital septum which includes fat and ocular muscles. | |
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| ===History and Symptoms=== | | ==[[Orbital cellulitis risk factors|Risk Factors]]== |
| Patients present with sudden onset of fever, [[proptosis]], restricted eye movement, and swelling and redness of the eye lids. It is usually caused by a previous sinusitis. Patients commonly complain of pain when moving the eye, sudden loss of vision, bulging of the eye or eyes that are infected and limited eye movement. Along with these symptoms, patients typically have redness and swelling of the eyelid, pain, discharge, inability to open the eye, occasional fever and lethargy. It is usually caused by a previous [[sinusitis]]. Other causes include infection of nearby structures, trauma and previous surgery.
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| === Physical Examination === | | ==[[Orbital cellulitis screening|Screening]]== |
| ==== Eyes ====
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| [[Image:Orbital_Cellulitis.jpg|thumb|150px|left|Orbital Cellulitis<ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages</ref>]] | |
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| ==== MRI and CT ==== | |
| [[Image:pre- and post-septal Orbital Cellulitis.jpg|thumb|150px|left|Pre- and post-septal Orbital Cellulitis<ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages</ref>]]
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| ==N, C and P== | | ==[[Orbital cellulitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| The feared complications include [[cavernous sinus thrombosis]] and [[meningitis]]. Abscess formation is another complication and may require surgical drainage.
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| Complications include hearing loss, blood infection, [[meningitis]], and optic nerve damage (which could lead to blindness).
| | ==Diagnosis== |
| | [[Orbital cellulitis history and symptoms|History and Symptoms]] | [[Orbital cellulitis physical examination|Physical Examination]] | [[Orbital cellulitis laboratory findings|Laboratory Findings]] | [[Orbital cellulitis x ray|X Ray]] | [[Orbital cellulitis CT|CT]] | [[Orbital cellulitis MRI|MRI]] | [[Orbital cellulitis ultrasound|Ultrasound]] | [[Orbital cellulitis other imaging findings|Other Imaging Findings]] | [[Orbital cellulitis other diagnostic studies|Other Diagnostic Studies]] |
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| Although orbital cellulitis is considered an ophthalmic emergency the prognosis is good if prompt medical treatment is received.
| | ==Treatment== |
| ==Death and blindness rates without treatment== | | [[Orbital cellulitis medical therapy|Medical Therapy]] | [[Orbital cellulitis surgery|Surgery]] | [[Orbital cellulitis primary prevention|Primary Prevention]] | [[Orbital cellulitis secondary prevention|Secondary Prevention]] | [[Orbital cellulitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Orbital cellulitis future or investigational therapies|Future or Investigational Therapies]] |
| Bacterial infections of the orbit have long been associated with a risk of catastrophic local
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| sequelae and intracranial spread.
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| The natural course of the disease, as documented by Gamble (1933), in the pre-antibiotic era,
| | ==Case Studies== |
| resulted in death in 17% of patients and permanent blindness in 20%.
| | [[Orbital cellulitis case study one|Case #1]] |
| | | ==Related Chapters== |
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| == Treatment == | |
| Because of concern for spread of infection, patients must be admitted to the hospital to receive intravenous antibiotics.
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| Orbital cellulitis is considered an ophthalmological emergency.
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| Prompt treatment is vital for a patient when fighting orbital cellulitis. Treatment typically involves IV antibiotics in the hospital and frequent observation (every 4-6 hours). Along with this several laboratory tests are run including a complete blood count, differential, and blood culture.
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| * '''Antibiotic Therapy''' - Since orbital cellulitis is commonly caused by Staphylococcus and Streptococcus species both penicillins and cephalosporins are typically the best choices for IV antibiotics. However, due to the increasing rise of [[MRSA]] (methicillin-resistant Staphylococcus aureus) orbital cellulitis can also be treated with [[Vancomycin]], [[Clindamycin]], or [[Doxycycline]]. If improvement is noted after 48 hours of IV antibiotics, healthcare professions can then consider switching a patient to oral antibiotics (which must be used for 2-3 weeks).
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| * '''Surgical Intervention''' - An abscess can threaten the vision or neurological status of a patient with orbital cellulitis, therefore sometimes surgical intervention is necessary. Surgery typically requires drainage of the sinuses and if a subperiosteal abscess is present in the medial orbit, drainage can be performed endoscopically. Post-operatively, patients must follow up regularly with their surgeon and remain under close observation.
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| ==See also== | |
| * [[Periorbital cellulitis]] | | * [[Periorbital cellulitis]] |
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| ==External links==
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| * [http://eyelearn.med.utoronto.ca/Lectures05-06/RedEye/05Orbit.htm University of Toronto]
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| * [http://www.nlm.nih.gov/medlineplus/ency/article/001012.htm MedlinePlus].
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| ==References==
| | {{WikiDoc Help Menu}} |
| * {{cite journal |author=Howe L, Jones N |title=Guidelines for the management of periorbital cellulitis/abscess |journal=Clin Otolaryngol Allied Sci |volume=29 |issue=6 |pages=725-8 |year=2004 |pmid=15533168}}
| | {{WikiDoc Sources}} |
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| [[Category:Infectious disease]]
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| [[Category:Bacterial diseases]] | | [[Category:Bacterial diseases]] |
| [[Category:Disease stubs]]
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| [[Category:Ophthalmology]] | | [[Category:Ophthalmology]] |
| | | [[Category:Disease]] |
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| | [[Category:Emergency mdicine]] |
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| | [[Category:Up-To-Date]] |
| | [[Category:Infectious disease]] |