Internal Medicine

0521779407-16 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

Oral Lichen Planus Orbital Cellulitis 1087

management

■no curative treatment

■establish diagnosis

■control pain

specific therapy

■topical or systemic corticosteroids to control offending lymphocytes

■prednisone

■fluocinonide 0.05% ointment mixed with equal parts Orabase B

paste; use 3–5×daily

■clobetasol 0.05% gel; use 3–5×daily

follow-up

■periodic and as necessry for flares

complications and prognosis

■no cure; control symptoms

■small risk for malignant transformation to squamous cell carcinoma

ORBITAL CELLULITIS

RICHARD A. JACOBS, MD, PhD

history & physical

History

■Predisposing factors include sinusitis, dental infection, trauma and

spread of contiguous infections (conjunctivitis, dacrocystitis).

■Two distinct clinical syndromes: preseptal cellulitis (anterior to the

orbital septum) and postseptal or orbital cellulitis involving the

orbital contents

■Preseptal cellulitis caused byStaphylococcus aureusand streptococci

■Orbital cellulitis caused by organisms that cause acute and chronic

sinusitis –S. pneumoniaeand other streptococci, Haemophilus

influenzae, Moraxella catarrhalis, S. aureus and anaerobes

Signs & Symptoms

■Preseptal cellulitis – chemosis, conjunctival injection; pain, swelling

and erythema of eyelid

■Orbital cellulitis – signs and symptoms as above plus proptosis,

impaired ocular mobility and decreased vision (late manifestation);

fever and headache common