Orbital Cellulitis

Classify suspected infection as orbital cellulitis when eyelid swelling is accompanied by pain with eye movement, restricted extraocular movements or ophthalmoplegia, proptosis, or decreased vision. These findings distinguish postseptal involvement from preseptal cellulitis and should trigger emergency-level imaging and admission rather than outpatient observation. PubMed+1PubMedManagement of preseptal and orbital cellulitisPubMedOrbital Cellulitis - StatPearls - NCBI Bookshelf

Assess and document visual acuity, pupillary responses, ocular motility, degree of proptosis, eyelid examination, and fever or systemic toxicity before treatment whenever this does not delay therapy. Reduced visual acuity, a firm globe, proptosis, and impaired ocular motility also raise concern for orbital compartment syndrome, which is a clinical diagnosis requiring urgent ophthalmic assessment. ajnrajnrRadiologic Manifestations of Orbital Compartment Syndrome

Treat suspected orbital cellulitis as a time-sensitive infection because delayed recognition can progress to orbital abscess, blindness, intracranial extension, meningitis, or intracranial abscess. Acute sinusitis commonly precedes orbital cellulitis, whereas preseptal cellulitis more often follows trauma or bacteremia; this history changes the likelihood of a sinus-driven postseptal process but does not replace the ocular examination. JAMA+1JAMAOrbital Complications of Acute Sinusitis: Changes in the ...PubMedEpidemiology and Management of Orbital Cellulitis in Children - PMC

Obtain contrast-enhanced CT of the orbits and paranasal sinuses when examination suggests orbital cellulitis or cannot reliably exclude it. CT is the acute first-line modality and can demonstrate orbital soft-tissue inflammation, proptosis, subperiosteal or orbital inflammation, sinusitis, and abscess. PubMed+2PubMedPeriorbital Cellulitis - StatPearls - NCBI Bookshelfpubs rsnaNontraumatic Orbital Conditions: Diagnosis with CT and ...pedsinreview aappublicationsVisual Diagnosis: A 9-year-old Girl Who Has Fever, ...

Use MRI when CT does not adequately address soft-tissue extent or when intracranial complications are a concern. CT and MRI can differentiate preseptal from orbital disease and help exclude alternative causes of lid swelling and proptosis, including retinoblastoma and rhabdomyosarcoma; however, imaging alone may not resolve all distinctions among cellulitis, orbital inflammatory syndrome, and lymphoid lesions. PubMed+2PubMedPeriorbital Cellulitis - StatPearls - NCBI BookshelfPubMedPreseptal and orbital cellulitis: how to identify and treat these conditions – and save lives - PMCajnrMR Imaging of Orbital Inflammatory Syndrome ...

In admitted children with orbital cellulitis, obtain blood culture and consider eye, nasal, and throat swabs alongside full blood count as part of the hospital evaluation. Imaging and microbiologic testing should not postpone intravenous antimicrobial treatment in a clinically convincing postseptal infection. PubMedPubMedPreseptal and orbital cellulitis: how to identify and treat these conditions – and save lives - PMC

Admit patients with orbital cellulitis for intravenous antibiotics and close clinical monitoring. Pediatric care should be multidisciplinary, involving pediatric or medical clinicians, ophthalmologists, and ENT surgeons; the same coordination is appropriate for adults when sinus surgery or orbital drainage may be required. Initial intravenous regimens cited for children include flucloxacillin or ceftriaxone, with regimen selection guided by local microbiology and patient factors. PubMedPubMedPreseptal and orbital cellulitis: how to identify and treat these conditions – and save lives - PMC

The microbiology can be polymicrobial, including aerobic and anaerobic bacteria; fungal and mycobacterial causes are also reported. A sinus source is common, with spread from adjacent sinuses accounting for approximately 90% of cases in one clinical review. Therefore, review sinus imaging with ENT early rather than treating orbital findings as an isolated eyelid infection. PubMed+1PubMedOrbital Cellulitis - StatPearls - NCBI BookshelfPubMedPreseptal and orbital cellulitis: how to identify and treat these conditions – and save lives - PMC

Reserve outpatient oral treatment for mild preseptal cellulitis in adults and children older than 1 year who have no systemic toxicity and reliable access to close follow-up. Oral options described for preseptal cellulitis include amoxicillin-clavulanate, cefpodoxime, or cefdinir. Where MRSA coverage is indicated, clindamycin or TMP-SMX may be paired with amoxicillin-clavulanate, cefpodoxime, or cefdinir because TMP-SMX does not cover group A Streptococcus; doxycycline is unsuitable for children 8 years or younger. Typical preseptal treatment duration is 5 to 7 days, extended if cellulitis persists. PubMed+1PubMedManagement of preseptal and orbital cellulitisPubMedPeriorbital Cellulitis - StatPearls - NCBI Bookshelf

If a patient initially treated as preseptal cellulitis worsens or fails to respond, transition promptly to intravenous antibiotics, repeat the orbital examination, obtain or reassess imaging, and broaden the differential to resistant infection or an alternative diagnosis. A failure to improve after 48 hours was used as a trigger for treatment escalation in one hospitalized pediatric cohort, but clinical deterioration at any time warrants earlier reassessment. PubMed+1PubMedManagement of preseptal and orbital cellulitisPubMedEvaluating hospitalized children for preseptal cellulitis: A single-center experience and current literature review

Use imaging to identify subperiosteal orbital abscess, orbital abscess, or intracranial spread. Preseptal and postseptal cellulitis can generally be managed nonsurgically, whereas orbital abscess and cavernous sinus thrombosis are generally managed surgically. Involve ENT and ophthalmology when CT or MRI shows a collection or when clinical findings indicate orbital compromise. PubMed+1PubMedManagement of pediatric orbital cellulitis: A systematic reviewpubs rsnaEmergency Imaging Assessment of Acute, Nontraumatic ...

Monitor inpatient patients with serial visual acuity, pupillary responses, ocular motility, proptosis, eyelid findings, fever, and overall clinical trajectory. Any new decrease in vision, worsening ocular motility, increasing proptosis, or concern for compartment syndrome should prompt immediate ophthalmic reassessment rather than waiting for a routine interval evaluation. PubMed+1PubMedManagement of preseptal and orbital cellulitisajnrRadiologic Manifestations of Orbital Compartment Syndrome

Use response to treatment as a diagnostic checkpoint. Persistent or worsening swelling despite intravenous therapy should prompt review of the CT or MRI for a missed collection, reassessment of sinus source control, microbiologic reassessment, and consideration of a noninfectious orbital process or tumor. PubMed+2PubMedManagement of preseptal and orbital cellulitisPubMedPreseptal and orbital cellulitis: how to identify and treat these conditions – and save lives - PMCajnrMR Imaging of Orbital Inflammatory Syndrome ...