Orbital cellulitis physical examination: Difference between revisions
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*[[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. Additionaly, there may be involvement of the III, IV, and VI [[cranial | *Ocular motility and presence of pain with eye movements. Additionaly, there may be involvement of the III, IV, and VI [[cranial nerves]] in cases of [[cavernous sinus]] involvement. | ||
*[[Orbit]] exam should include documentation of direction of displacement of the globe | *[[Orbit]] exam should include documentation of direction of displacement of the globe | ||
*Measurement of [[intraocular pressure]] (IOP) | *Measurement of [[intraocular pressure]] (IOP) | ||
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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]] | ||
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====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==== | ||
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====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 | ||
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====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 purulent [[discharge]] | ||
*[[Erythema]] and [[edema]] of the [[nares]], [[nasopharynx]] and [[sinuses]]. | *[[Erythema]] and [[edema]] of the [[nares]], [[nasopharynx]] and [[sinuses]]. | ||
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====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 tonsils | ||
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===Neck=== | ===Neck=== | ||
Patients with orbital cellulitis may present with tender [[cervical lymph nodes]]. | 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]], which are suggestive of [[upper respiratory tract infection]]. | Patients with orbital cellulitis may present with [[wheezing]] or [[coughing]], which are suggestive of [[upper respiratory tract infection]]. | ||
==References== | ==References== | ||
Revision as of 17:09, 2 August 2016
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]
- Vital signs
- Best-corrected visual acuity(BCVA)
- Color vision assessment
- Proptosis measurements using Hertel exophthalmometry
- Visual field assessment
- 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. Additionaly, there may be involvement of the III, IV, and VI cranial nerves in cases of cavernous sinus involvement.
- Orbit exam should include documentation of direction of displacement of the globe
- Measurement of intraocular pressure (IOP)
- Slit-lamp test in cases of severe proptosis
- Dilated fundus exam to exclude optic neuropathy or retinal vascular occlusion.
- Nasal sinus examination
- Otoscopy for presence of otitis media
- Oral examination for oropharyngeal infection and dentition
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:
- Periorbital edema and erythema
- Proptosis
- Chemosis
- Ophthalmoplegia
- Restricted or painful ocular movements
- Reduced visual acuity
- Increased intraocular pressure (IOP)
- Displacement of the globe
- Diminished visual field
- Signs of orbital trauma, or periorbital surgery (scars, injuries)
- Signs of periorbital insect bites
Ear
Patients with orbital cellulitis may present with signs which are suggestive of inner or middle ear infection:
- Erythema, edema and discharge present on otoscopy
- Reduced hearing
- Children may show signs of "tugging" on the affected ear
Nose
Patients with orbital cellulitis may present with signs which are suggestive of sinusitis:
- Nasal purulent discharge
- Erythema and edema of the nares, nasopharynx and sinuses.
- Painful sinuses upon applying pressure
Throat/Oral
Patients with orbital cellulitis may present with signs which are suggestive of oral, pharyngeal, or upper respiratory tract infections:
- Erythematous oropharynx
- Exudative tonsils
- Dental caries
- Tooth abscess
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
- ↑ 1.0 1.1 1.2 American Academy of Ophthalmology EyeWiki (2015)http://eyewiki.aao.org/Orbital_Cellulitis
- ↑ 2.0 2.1 Stanford Orbital Cellulitis Summary (2011)http://peds.stanford.edu/Rotations/blue_team/documents/Periorbital_and_Orbital_Cellulitis_Summary.pdf
- ↑ 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.
- ↑ 4.0 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.
- ↑ 5.0 5.1 Hasanee K, Sharma S (2004). "Ophthaproblem. Orbital cellulitis". Can Fam Physician. 50: 359, 365, 367. PMC 2214559. PMID 15318671.
- ↑ 6.0 6.1 Merck Manual Professional Version (2016)https://www.merckmanuals.com/professional/eye-disorders/orbital-diseases/preseptal-and-orbital-cellulitis