Orbital cellulitis physical examination: Difference between revisions
Jump to navigation
Jump to search
Tarek Nafee (talk | contribs) (→Eyes) |
Tarek Nafee (talk | contribs) No edit summary |
||
| Line 1: | Line 1: | ||
__NOTOC__ | __NOTOC__ | ||
{{CMG}}; {{AE}}{{TarekNafee}} | {{CMG}}; {{AE}} {{TarekNafee}} | ||
{{Orbital cellulitis}} | {{Orbital cellulitis}} | ||
==Overview== | ==Overview== | ||
| Line 10: | Line 10: | ||
*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. | *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. | ||
*[[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 (eye)|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]] | ||
| Line 24: | Line 24: | ||
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> | 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: | ||
| Line 32: | Line 32: | ||
*[[Tachypnea]] | *[[Tachypnea]] | ||
===Skin=== | ===Skin=== | ||
Patients with orbital cellulitis | 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 | ||
| Line 39: | Line 39: | ||
====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==== | ||
| Line 82: | Line 82: | ||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category:Ophthalmology]] | [[Category:Ophthalmology]] | ||
[[Category:FinalQCRequired]] | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Revision as of 16:35, 2 August 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [2]
|
Orbital cellulitis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Orbital cellulitis physical examination On the Web |
|
American Roentgen Ray Society Images of Orbital cellulitis physical examination |
|
Risk calculators and risk factors for Orbital cellulitis physical examination |
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.Also, there might be involvement of the III, IV, and VI cranial nerve 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:
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 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:
- 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
- Erythematous oropharynx
- Exudative tonsils
- Dental caries
- Tooth abscess
Neck
Patients with orbital cellulitis may present with tender cervical lymph nodes.
Lung
Patients with orbital cellulitis may present wheezing or coughing, indicating 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