Internal Medicine

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

1088 Orbital Cellulitis Orbital Tumors

tests

■Gram stain and culture of any purulent drainage

■Blood cultures, if febrile

■Thin-section CT and/or MRI to document orbital and sinus involve-

ment

differential diagnosis

■Pseudotumor and orbital tumors – fever and inflammation NOT

present in these entities

management

■Distinguish preseptal from orbital cellulitis.

■Orbital cellulitis always hospitalized; consult ENT and ophthalmol-

ogy to assess need to drain sinuses and orbit

■Preseptal cellulitis can be treated as outpatient, if disease mild.

specific therapy

■Preseptal cellulitis – dicloxacillin, cephalexin or clindamycin (severe

penicillin allergy) as outpatient; naficillin, cefazolin or vancomycin

for hospitalized patient

■Orbital cellulitis – Unasyn, Zosyn or ceftriaxone plus metronidazole;

clindamycin plus a fluoroquinolone, if penicillin allergic

follow-up

■Preseptal cellulitis responds in several days.

■Orbital cellulitis slower response to therapy; evaluate vision once or

twice daily – if not improved or worsens in 48 hours, repeat CT or

MRI

complications and prognosis

■Preseptal cellulitis – eyelid abscess (S. aureus) requiring drainage,

but recovery complete

■Orbital cellulitis – vision loss, cavernous sinus thrombosis, enucle-

ation

ORBITAL TUMORS

DEVRON H. CHAR, MD

history & physical

■Proptosis, diplopia, decreased vision, or eyelid abnormalities.

tests

■Ophthalmic oncologic evaluation.