HEAD, EYE, EAR, NOSE, AND THROAT
EMERGENCIES■ Children <3 years old
■ Culprits:Streptococcus,Staphylococcus, and H. influenza
■ Caused by extension from ethmoid sinusitis, skin infections (bug bite), or
traumaSYMPTOMS/EXAM
■ Unilateral erythema, warmth, and edema of the eyelid
■ Conjunctival injection
■ May see fever
■ Normal visual acuity and ocular motility
■ Minimal painTREATMENT
■ Blood cultures, if febrile
■ CT of orbits (3-mm fine cuts) if cannot rule out orbital cellulites
■ Early/mild cases can be treated as outpatient with reliable follow-up in
24 hours.
■ Broad spectrum antibiotics
■ When in doubt, admit!COMPLICATIONS
■ Orbital cellulitisOrbital Cellulitis
■ An infection of tissues within the orbit, posterior to the orbital septum
■ 90% of cases are due to spread from ethmoid sinus.
■ Typical microbes are those of acute sinusitis, including Streptococcussp.,
S. aureus,and H. influenzae type B.
■ Fungal infection may occur in immunocompromised.
■ Occurs in all ages, but most common in kids
■ Infection may be complicated by abscess formation.SYMPTOMS/EXAM
Eye and eyelid findings in patients with orbital cellulitis may look very similar to
that of periorbital cellulitis. However, orbital cellulitis is typically distinguished
by the additional findings of:
■ Worse pain with eye movement
■ Visual changes or diplopia
■ Decreased extraocular muscle function
■ Decreased papillary response
■ Fever/toxic appearance
■ Increased IOPTREATMENT
■ CT of orbits with 1- to 3-mm cuts
■ Blood cultures
■ Gram stain and culture
■ Broad spectrum IV antibiotics (ceftriaxone + clindamycin or ampicillin/
sulbactam)
■ Urgent ophthalmology consultation and admissionPain with eye movements and
restriction of eye movements
distinguish orbital cellulitis
from preorbital cellulitis.