Orbital cellulitis physical examination: Difference between revisions

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__NOTOC__
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{{CMG}}; {{AE}}{{TarekNafee}}
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{{Orbital cellulitis}}
{{Orbital cellulitis}}
==Overview==
==Overview==
Patients with orbital cellulitis usually appear ill. Physical examination of patients with orbital cellulitis is usually remarkable for [[fever]], [[proptosis]], [[ophthalmoplegia]], and impaired [[visual acuity]]. Patients should undergo a complete [[physical examination]], paying particular attention to [[general appearance]], [[vital signs]], [[visual acuity]], [[visual field]], orbital positioning, ocular movmements, [[oropharynx]], and [[nasopharynx]] examinations.<br>
Patients with orbital cellulitis usually appear ill. Physical examination of patients with orbital cellulitis is usually remarkable for [[fever]], [[proptosis]], [[ophthalmoplegia]], and impaired [[visual acuity]]. Patients should undergo a complete [[physical examination]], paying particular attention to general appearance, [[vital signs]], [[visual acuity]], [[visual field]], orbital positioning, ocular movmements, [[oropharynx]], and [[nasopharynx]] examinations.<ref name=Eyewikiorbitalcellulitis>American Academy of Ophthalmology EyeWiki (2015)http://eyewiki.aao.org/Orbital_Cellulitis</ref><ref name=orbitalcellulitiisstanford>Stanford Orbital Cellulitis Summary (2011)http://peds.stanford.edu/Rotations/blue_team/documents/Periorbital_and_Orbital_Cellulitis_Summary.pdf</ref><ref name="pmid22224014">{{cite journal| author=Lam Choi VB, Yuen HK, Biswas J, Yanoff M| title=Update in pathological diagnosis of orbital infections and inflammations. | journal=Middle East Afr J Ophthalmol | year= 2011 | volume= 18 | issue= 4 | pages= 268-76 | pmid=22224014 | doi=10.4103/0974-9233.90127 | pmc=3249811 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22224014  }} </ref><ref name="pmid22346113">{{cite journal| author=Chaudhry IA, Al-Rashed W, Arat YO| title=The hot orbit: orbital cellulitis. | journal=Middle East Afr J Ophthalmol | year= 2012 | volume= 19 | issue= 1 | pages= 34-42 | pmid=22346113 | doi=10.4103/0974-9233.92114 | pmc=3277022 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22346113  }} </ref><ref name="pmid15318671">{{cite journal| author=Hasanee K, Sharma S| title=Ophthaproblem. Orbital cellulitis. | journal=Can Fam Physician | year= 2004 | volume= 50 | issue=  | pages= 359, 365, 367 | pmid=15318671 | doi= | pmc=2214559 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15318671  }} </ref><ref name=merckmanualorbitalcellulitis> Merck Manual Professional Version (2016)https://www.merckmanuals.com/professional/eye-disorders/orbital-diseases/preseptal-and-orbital-cellulitis</ref>
 
==Physical Examination==
==Physical Examination==
Patients with orbital cellulitis usually appear ill. Physical examination of patients with orbital cellulitis is usually remarkable for [[fever]], [[proptosis]], [[ophthalmoplegia]], and impaired [[visual acuity]].The physical examination should assess:(EYE WIKI)
Patients with orbital cellulitis usually appear ill. Physical examination of patients with orbital cellulitis is usually remarkable for [[fever]], [[proptosis]], [[ophthalmoplegia]], and impaired [[visual acuity]].The physical examination should assess:<ref name=Eyewikiorbitalcellulitis>American Academy of Ophthalmology EyeWiki (2015)http://eyewiki.aao.org/Orbital_Cellulitis</ref>
*Vital signs
*[[Vital signs]]
*Best-corrected visual acuity(BCVA)
*[[visual acuity|Best-corrected visual acuity]](BCVA)
*Color vision assessment
*Color vision assessment
*Proptosis measurements using Hertel exophthalmometry
*[[Proptosis]] measurements using Hertel exophthalmometry
*Visual field assessment
*[[Visual field]] assessment
*Assessment of pupillary function with particular attention paid to the presence of a relative afferent pupillary defect(rAPD)
*Assessment of [[pupillary]] function with particular attention paid to the presence of a relative afferent [[pupillary]] defect (rAPD)
*Ocular motility and presence of pain with eye movements.Also, there might be involvement of the III, IV, and VI cranial nerve in cases of cavernous sinus involvement
*[[Eye movement|Ocular motility]] and presence of pain with eye movements; additionally, there may be involvement of the [[Oculomotor nerve|III]], [[Trochlear nerve|IV]], and [[Abducent nerve|VI]] [[cranial nerves]] in cases of [[cavernous sinus]] involvement.
*Orbit exam should include documentation of direction of displacement of globe
*[[Orbit]] exam should include documentation of direction of displacement of the globe
*Measurement of intraocular pressure (IOP)
*Measurement of [[intraocular pressure]] (IOP)
*Slit-lamp test in cases of severe proptosis
*[[Slit lamp]] test in cases of severe [[proptosis]]
*Dilated fundus exam to exclude optic neuropathy or retinal vascular occlusion.
*[[Dilated fundus exam]] to exclude optic [[neuropathy]] or retinal vascular occlusion
*Nasal sinus examination
*Nasal [[sinus]] examination
*Otoscopy for presence of otitis media
*[[Otoscopy]] for presence of [[otitis media]]
*Oral examination for oropharyngeal infection and dentition
*Oral examination for [[oropharyngeal]] [[infection]] and [[dentition]]


==Signs==
==Signs==
After a complete and thorough physical examination, patients with orbital cellulitis may present with some or all of the following signs:
Patients with orbital cellulitis may present with some or all of the following signs:<ref name=Eyewikiorbitalcellulitis>American Academy of Ophthalmology EyeWiki (2015)http://eyewiki.aao.org/Orbital_Cellulitis</ref><ref name=orbitalcellulitiisstanford>Stanford Orbital Cellulitis Summary (2011)http://peds.stanford.edu/Rotations/blue_team/documents/Periorbital_and_Orbital_Cellulitis_Summary.pdf</ref><ref name="pmid22224014">{{cite journal| author=Lam Choi VB, Yuen HK, Biswas J, Yanoff M| title=Update in pathological diagnosis of orbital infections and inflammations. | journal=Middle East Afr J Ophthalmol | year= 2011 | volume= 18 | issue= 4 | pages= 268-76 | pmid=22224014 | doi=10.4103/0974-9233.90127 | pmc=3249811 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22224014  }} </ref><ref name="pmid22346113">{{cite journal| author=Chaudhry IA, Al-Rashed W, Arat YO| title=The hot orbit: orbital cellulitis. | journal=Middle East Afr J Ophthalmol | year= 2012 | volume= 19 | issue= 1 | pages= 34-42 | pmid=22346113 | doi=10.4103/0974-9233.92114 | pmc=3277022 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22346113  }} </ref><ref name="pmid15318671">{{cite journal| author=Hasanee K, Sharma S| title=Ophthaproblem. Orbital cellulitis. | journal=Can Fam Physician | year= 2004 | volume= 50 | issue=  | pages= 359, 365, 367 | pmid=15318671 | doi= | pmc=2214559 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15318671  }} </ref><ref name=merckmanualorbitalcellulitis> Merck Manual Professional Version (2016)https://www.merckmanuals.com/professional/eye-disorders/orbital-diseases/preseptal-and-orbital-cellulitis</ref>
===General Appearance===
===General Appearance===
Patients with orbital cellulitis usually appear ill and have marked inflammation and edema of the periorbital area.
Patients with orbital cellulitis usually appear ill and have marked [[inflammation]] and [[edema]] of the periorbital area.
===Vital Signs===
===Vital Signs===
Patients with orbital cellulitis may have the following vital signs:
Patients with orbital cellulitis may have the following [[vital signs]], which are suggestive of [[infection]]:
*[[Fever]]
*[[Fever]]
*[[Hypotension]]
*[[Hypotension]]
*[[Tachycardia]]
*[[Tachycardia]]
*[[Tachypnea]]
*[[Tachypnea]]
===Skin===
===Skin===
Patients with orbital cellulitis usually have the following skin findings:
Patients with orbital cellulitis may present with the following skin findings:
*[[Erythema]] of the periorbital skin and eyelid
*[[Erythema]] of the periorbital skin and [[eyelid]]
*[[Edema]] of the periorbital skin and eyelid
*[[Edema]] of the periorbital skin and [[eyelid]]
===HEENT===
===HEENT===
Patients with orbital cellulitis may have the following HEENT findings on physical examination:
Patients with orbital cellulitis may have the following HEENT findings on physical examination:
====Head====
====Head====
Patients with orbital cellulitis may present with the following signs:
Patients with orbital cellulitis may present with the following signs:
*Evidence of recent orbital or head trauma or surgery (e.g. scars, injuries, etc.)
*Evidence of recent orbital or head [[trauma]], or surgery (e.g., scars, injuries, etc.)
*Evidence of recent insect bites
*Evidence of recent [[insect bites]]
====Eyes====
====Eyes====
Patients with orbital cellulitis may present with some or all the following signs:
Patients with orbital cellulitis may present with some or all the following signs:
*Periorbital [[edema]] and [[erythema]]
*Periorbital [[edema]] and [[erythema]]
*[[Proptosis]]
*[[Proptosis]]
*[[Chemosis]]
*[[Ophthalmoplegia]]
*[[Ophthalmoplegia]]
*Restricted or painful ocular movements
*Restricted or painful ocular movements
*Reduced visual acuity
*Reduced [[visual acuity]]
*Increased [[intraocular pressure]] (IOP)
*Increased [[intraocular pressure]] (IOP)
*Displacement of the globe
*Displacement of the globe
*Diminished visual field
*Diminished [[visual field]]
*Signs of orbital trauma, or periorbital surgery (scars, injuries)
*Signs of orbital trauma, or periorbital surgery (scars, injuries)
*Signs of periorbital insect bites
*Signs of periorbital [[insect bites]]


====Ear====
====Ear====
Patients with orbital cellulitis may present with signs of [[otitis interna|inner]] or [[otitis media|middle ear infection]]:
Patients with orbital cellulitis may present with signs which are suggestive of [[otitis interna|inner]] or [[otitis media|middle ear infection]]:
*Erythema, edema and discharge present on otoscopy
*[[Erythema]], [[edema]] and [[discharge]] present on [[otoscopy]]
*Reduced hearing
*Reduced hearing
*Children may show signs of "tugging" on the affected ear
*Children may show signs of "tugging" on the affected ear
====Nose====
====Nose====
Patients with orbital cellulitis may present with:
Patients with orbital cellulitis may present with signs which are suggestive of [[sinusitis]]:
*Nasal [[purulent discharge]]  
*Nasal [[discharge|purulent discharge]]  
*[[Erythema]] and [[edema]] of the nares, nasopharynx and sinuses.
*[[Erythema]] and [[edema]] of the [[nares]], [[nasopharynx]], and [[sinuses]]
*Painful [[sinuses]] upon applying pressure
*Painful [[sinuses]] upon applying pressure
====Throat/Oral====
====Throat/Oral====
Patients with orbital cellulitis may present with  
Patients with orbital cellulitis may present with signs which are suggestive of [[oral]], [[pharyngeal]], or [[upper respiratory tract infection|upper respiratory tract]] infections:
*Erythematous [[oropharynx]]
*[[Erythematous]] [[oropharynx]]
*[[Exudative tonsils]]
*Exudative [[Tonsil|tonsils]]
*[[Dental caries]]
*[[Dental caries]]
*[[Tooth abscess]]
*[[Tooth abscess]]


===Neck===
Patients with orbital cellulitis may present with tender [[cervical lymph nodes]], which are suggestive of regional [[infection]].
===Lung===
===Lung===
Patients with orbital cellulitis may present [[wheezing]] or [[coughing]], indicating [[upper respiratory tract infection]].
Patients with orbital cellulitis may present with [[wheezing]] or [[coughing]], which are suggestive of [[upper respiratory tract infection]].


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}


[[Category:Disease]]
[[Category:Disease]]
[[Category:Ophthalmology]]
[[Category:FinalQCRequired]]
[[Category:Emergency mdicine]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Ophthalmology]]
{{WH}}
{{WS}}

Latest revision as of 23:26, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [2]

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Overview

Patients with orbital cellulitis usually appear ill. Physical examination of patients with orbital cellulitis is usually remarkable for fever, proptosis, ophthalmoplegia, and impaired visual acuity. Patients should undergo a complete physical examination, paying particular attention to general appearance, vital signs, visual acuity, visual field, orbital positioning, ocular movmements, oropharynx, and nasopharynx examinations.[1][2][3][4][5][6]

Physical Examination

Patients with orbital cellulitis usually appear ill. Physical examination of patients with orbital cellulitis is usually remarkable for fever, proptosis, ophthalmoplegia, and impaired visual acuity.The physical examination should assess:[1]

Signs

Patients with orbital cellulitis may present with some or all of the following signs:[1][2][3][4][5][6]

General Appearance

Patients with orbital cellulitis usually appear ill and have marked inflammation and edema of the periorbital area.

Vital Signs

Patients with orbital cellulitis may have the following vital signs, which are suggestive of infection:

Skin

Patients with orbital cellulitis may present with the following skin findings:

HEENT

Patients with orbital cellulitis may have the following HEENT findings on physical examination:

Head

Patients with orbital cellulitis may present with the following signs:

  • Evidence of recent orbital or head trauma, or surgery (e.g., scars, injuries, etc.)
  • Evidence of recent insect bites

Eyes

Patients with orbital cellulitis may present with some or all the following signs:

Ear

Patients with orbital cellulitis may present with signs which are suggestive of inner or middle ear infection:

Nose

Patients with orbital cellulitis may present with signs which are suggestive of sinusitis:

Throat/Oral

Patients with orbital cellulitis may present with signs which are suggestive of oral, pharyngeal, or upper respiratory tract infections:

Neck

Patients with orbital cellulitis may present with tender cervical lymph nodes, which are suggestive of regional infection.

Lung

Patients with orbital cellulitis may present with wheezing or coughing, which are suggestive of upper respiratory tract infection.

References

  1. ↑ 1.0 1.1 1.2 American Academy of Ophthalmology EyeWiki (2015)http://eyewiki.aao.org/Orbital_Cellulitis
  2. ↑ 2.0 2.1 Stanford Orbital Cellulitis Summary (2011)http://peds.stanford.edu/Rotations/blue_team/documents/Periorbital_and_Orbital_Cellulitis_Summary.pdf
  3. ↑ 3.0 3.1 Lam Choi VB, Yuen HK, Biswas J, Yanoff M (2011). "Update in pathological diagnosis of orbital infections and inflammations". Middle East Afr J Ophthalmol. 18 (4): 268–76. doi:10.4103/0974-9233.90127. PMC 3249811. PMID 22224014.
  4. ↑ 4.0 4.1 Chaudhry IA, Al-Rashed W, Arat YO (2012). "The hot orbit: orbital cellulitis". Middle East Afr J Ophthalmol. 19 (1): 34–42. doi:10.4103/0974-9233.92114. PMC 3277022. PMID 22346113.
  5. ↑ 5.0 5.1 Hasanee K, Sharma S (2004). "Ophthaproblem. Orbital cellulitis". Can Fam Physician. 50: 359, 365, 367. PMC 2214559. PMID 15318671.
  6. ↑ 6.0 6.1 Merck Manual Professional Version (2016)https://www.merckmanuals.com/professional/eye-disorders/orbital-diseases/preseptal-and-orbital-cellulitis

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