Presentation
Patients present with unilateral eyelid swelling and edema. Those with orbital cellulitis present with similar findings plus ocular symptoms such as proptosis, eye pain, decreased vision, limited extraocular motility. [ncbi.nlm.nih.gov]
Introduction Infections of the eye occur in the pediatric population and may present with complaints of eyelid swelling and pain. [pedsinreview.aappublications.org]
Orbital cellulitis: eyelid edema and erythema, diminished visual acuity, proptosis is present, relative afferent pupillary defect may be present, reduced color saturation, chemotic conjunctiva and reduced extraocular movements with pain elicited by these [eyewiki.org]
Patients in the non-insect bite group more commonly had fever at presentation (p Biography : Nadav Friedel has completed his MD at Semmelweis University, Budapest, Hungary in 2011. [longdom.org]
If any of these features is present, one must assume that the patient has orbital cellulitis and begin treatment with IV antibiotics. CT scan may be done to delineate the extension of the infection. [en.wikipedia.org]
Entire Body System
- Pain
Symptoms Symptoms include: Redness around the eye or in the white part of the eye Swelling of the eyelid, whites of eyes, and surrounding area This condition does not often affect vision or cause eye pain. [account.allinahealth.org]
In contrast to orbital cellulitis, patients with periorbital cellulitis do not have bulging of the eye ( proptosis ), limited eye movement ( ophthalmoplegia ), pain on eye movement, or loss of vision. [en.wikipedia.org]
Extraocular movements and visual acuity can be evaluated only partially due to pain. Introduction Infections of the eye occur in the pediatric population and may present with complaints of eyelid swelling and pain. [pedsinreview.aappublications.org]
The patient denies pain in the eye and denies any worsening or alleviating factors. Physical examination shows extraocular movements are normal. Additional vision testing in the office is unremarkable. [osmosis.org]
Severity of pain on day 3 assessed with: grouped visual analog scale Scale from: 1 to 5 The mean severity of pain on day 3 was 3.1. [cochranelibrary.com]
- Animal Bite
Preseptal cellulitis usually is caused by spread of an infection of the face or eyelid, an infected insect or animal bite, conjunctivitis, a hordeolum (stye), or sinusitis. [msdmanuals.com]
Skin
- Dermatitis
Contact dermatitis. Kawasaki’s disease (children). Idiopathic orbital inflammation. Thyroid eye disease. Dacryocystitis. Dacryoadenitis. [eyewiki.org]
Eyes
- Diplopia
Kestenbaum limbus test of motility) or at clinical exam and in the absence of any reported diplopia. [cochranelibrary.com]
- Strabismus
Pediatric Ophthalmology and Strabismus. Elsevier Saunders. 4th edition; China, 2013. Pp 89-99. ↑ Rose GE, Howard DJ, Watts MR. Periorbital necrotising fasciitis. Eye 1991; 5: 736–40. [eyewiki.org]
Neurologic
- Meningism
Central nervous system involvement (after orbital extension): meningitis, abscesses (brain, extradural or subdural). Necrotizing fasciitis: it is a rare complication caused by β-hemolytic Streptococcus. [eyewiki.org]
In very severe cases, patients may have meningitis. Although not always a true continuum, the conditions in this classification system present similarly and must be considered during the evaluation of a patient with ophthalmic complaints. [ncbi.nlm.nih.gov]
There is clinical precedence for the use of corticosteroids in several other acute infections, including bacterial meningitis (Brouwer 2015), tuberculosis meningitis (Prasad 2016), bacterial meningitis in neonates (Ogunlesi 2015), and acute bacterial [cochranelibrary.com]
Workup
Microbiology
- Staphylococcus Aureus
Typical signs include periorbital erythema, induration, tenderness and warmth. [2] Causes [ edit ] Staphylococcus aureus, Streptococcus pneumoniae, other streptococci, and anaerobes are the most common causes, depending on the origin of the infection. [en.wikipedia.org]
Staphylococcus aureus and epidermidis are commonly found after a penetrating eyelid trauma. Streptococcus pneumoniae is a common etiology in preseptal cellulitis secondary to sinusitis. [eyewiki.org]
However, there are now increasing instances of methicillin-resistant Staphylococcus aureus (MRSA) causing periorbital cellulitis. [ncbi.nlm.nih.gov]
There was an increase in Staphylococcus aureus (from 20% to 42%), and of those, there was methicillin‐resistance only in the postvaccine era (from 0% to 56%). [cochranelibrary.com]
Treatment
Treatment / Management The treatment of periorbital cellulitis differs based on the severity of disease and age of the patient. The mainstay of treatment is usually antibiotic coverage against S. aureus, the Streptococcus species, and anaerobes. [ncbi.nlm.nih.gov]
Treatment Antibiotics are given by mouth, by shots, or through a vein (intravenously; IV) to help fight the infection. [account.allinahealth.org]
You can help by adding to it. ( February 2019 ) Treatment [ edit ] Antibiotics are aimed at gram positive bacteria. Medical attention should be sought if symptoms persist beyond 2–3 days. [en.wikipedia.org]
Standard treatment plus systemic corticosteroids compared to standard treatment alone for periorbital and orbital cellulitis Standard treatment plus systemic corticosteroids compared to standard treatment alone for periorbital and orbital cellulitis Patient [cochranelibrary.com]
If the condition improves, treatment can be switched to the appropriate oral antibiotics based on cultures. [eyewiki.org]
Prognosis
Tests that may be ordered include: Blood culture Blood tests (complete blood count) CT scan MRI scan Outlook (Prognosis) Periorbital cellulitis almost always improves with treatment. [account.allinahealth.org]
Prognosis is usually good when this entity is promptly diagnosed and treated. However, complications can develop even with prompt treatment. [eyewiki.org]
Etiology
[…] that initiates the cellulitis 2,3 and others implying a direct causation. 1,4 The most frequently encountered pathogens have been Haemophilus influenzae in those patients with an upper respiratory tract infection; staphylococci and streptococci are etiologic [jamanetwork.com]
In the immunocompromised patient we must suspect fungi as a possible etiology. [eyewiki.org]
Most conditions of periorbital cellulitis resolve after five to seven days with proper antibiotics. [1] [2] [3] [4] Etiology Periorbital cellulitis is commonly caused by the spread of infection of rhinosinusitis or infection after a local trauma; therefore [ncbi.nlm.nih.gov]
Epidemiology
Epidemiology Periorbital cellulitis can occur at any age, but it is especially common in the pediatric population. Periorbital cellulitis is more common than orbital cellulitis. [ncbi.nlm.nih.gov]
Pathophysiology
Describe the cause, pathophysiology, and management of periorbital and orbital cellulitis. Understand the importance of sinus disease in both periorbital and orbital cellulitis. [pedsinreview.aappublications.org]
Pathophysiology The most common bacterial causes of periorbital cellulitis are Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus pyogenes. [ncbi.nlm.nih.gov]