3-26
Follow-up Actions
Return evaluation: Follow patients closely on daily basis for signs of improvement or worsening
Evacuation/Consultation Criteria: Evacuate as indicated above in treatment. Evacuate any patient not
showing improvement within 24-48 hours. Consult with an ophthalmologist if available prior to using steroids
in the eye.
Symptom: Eye Problems: Orbital or Periorbital Inflammation
MAJ Thomas Lovas, MC, USA & CAPT Frank Butler, MC, USNIntroduction: Orbital or periorbital inflammation can result from nasal cellulitis, orbital cellulitis, pseudotumor,
insect envenomation or lacrimal gland inflammation (dacryocystitis).
Subjective: Symptoms
Periocular edema, erythema, pain, possibly sensing a foreign body in or near the orbit.
Focused History: Has the sharpness of your vision decreased? Do you have pain in your eye or around your
eye? (typical symptoms) Do you feel you have something in your eye? (Foreign body sensation is due to
irritation or trauma of the cornea or conjunctival epithelium.)
Risk Factors: Has an insect bitten you? Have you had any recent infections in your teeth or sinuses? Have
you had any recent trauma to this eye? Do you wear contact lenses?
Objective: Signs
Using Basic Tools Clinical Findings Interpretations
Vital signs Fever May be indicative of orbital cellulitis
Printed material Check visual acuity* Corneal damage, discharge; dysfunction of
some aspect of vision
Flashlight Swollen eyelid(s); eye Indicates orbital or preseptal cellulitis
slightly protruding from orbit
when compared to opposite side
Using Advanced Tools Clinical Findings Interpretations
Ophthalmoscope Observe fundus for signs of May indicate advanced orbital disease
retinal or optic nerve disease
Fluorescein Strip Staining? May indicate corneal abrasion (initiation site
for cellulitis)
UV Light Enhances swelling
- Assess visual acuity with Snellen chart if available. Reading any printed material will provide a rough
measure of visual acuity.
Pearl: Check eye movements (decreased eye movements indicate orbital process)
Assessment:
Differential Diagnosis
Preseptal cellulitis- associated with a history of periocular trauma or hordeolum (stye), no proptosis (protrusion
of the eye), no restriction or pain with eye movement and no change in visual acuity.
Dacryocystitis- a specific type of preseptal cellulitis in which the source of the infection is an obstructed
nasolacrimal duct. The erythema and inflammation are localized to the area overlying the lacrimal sac at the
inferior nasal aspect of the lower lid.
Periocular insect envenomation- may have a papular or vesicular lesion at the site of envenomation.
Orbital cellulitis- associated with a history of sinusitis or upper respiratory tract infection, proptosis (protrusion
of the eye), restricted extraocular muscle motility, decreased visual acuity and/or fever. It can progress to