Medical management of orbital cellulitis

Starkey, Cindi R.; Steele, Russell W.

doi:10.1097/00006454-200110000-00017

Cited by 71 publications

(61 citation statements)

References 9 publications

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“…The selection of antibiotics in our patients is very similar to other reports [4,8,17,18]. The coverage of common organisms associated with acute sinusitis and other common etiologies should be considered in the empirical medical management of preseptal and OC.…”

Section: Discussionsupporting

confidence: 83%

Orbital and preseptal cellulitis: a 10-year survey of hospitalized patients in a tertiary eye hospital in Iran

et al. 2012

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To evaluate the demographic and clinical features of orbital cellulitis (OC) and preseptal cellulitis (PC) in a tertiary eye hospital over a 10-year period. This is a retrospective study of files of patients defined as OC or PC admitted to Labbafinejad Hospital, Tehran, Iran, in which clinical specificities and results of treatment and complications were reviewed. A total of 93 records of patients with OC or PC were identified from 1997 to 2007. 42 % of the patients had orbital and 58 % had PC. OC was found to be twice as common in males but PC occurred equally in both sexes. The mean ages ± SD of patients with OC and PC were 27.4 ± 23.9 and 19.1 ± 23.3 years, respectively. 97.8 % of involvements were unilateral. The most common complaint of the patients was change in lid appearance and the most common season of involvement was spring in both groups. Sinusitis was the most common background in 53.8 % of OC and 24.1 % of PC patients, and the sinus most commonly involved was the ethmoid. Surgical intervention was needed in 48.7 % of orbital and 14.8 % of PC. The only complication seen in OC was external ophthalmoplegia in a case which needed operation. In our geographical region, orbital and PC are seen most frequently in young patients in spring and their most common background is ethmoiditis; complications may be prevented by appropriate medical and/or surgical management.

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Section: Discussionsupporting

confidence: 83%

Orbital and preseptal cellulitis: a 10-year survey of hospitalized patients in a tertiary eye hospital in Iran

et al. 2012

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“…Treatment is initiated empirically because blood cultures are generally negative and it is difficult to obtain samples for culture from the area of infection. Although some authors argue that children older than one year who do not have toxic findings might be treated with oral antibiotics without hospitalization, all patients should be hospitalized and broad-spectrum parenteral antibiotic treatment directed to aerobic and anaerobic microorganisms should be initiated because it is difficult to clinically differentiate preseptal cellulitis from orbital cellulitis and because of potential complications (12,23). In adult and pediatric patients, a first-generation cephalosporin and amikacin combination is used frequently.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of patients with orbital infections

et al. 2018

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Aim: Orbital tissue infections are common infections of childhood that can lead to severe complications. Herein, we aimed to evaluate the etiologic factors, diagnosis, follow-up, and treatment procedures in pediatric patients with orbital infections. Material and Methods:This study was performed retrospectively between January 2014 and December 2015 in Cerrahpasa Medical Faculty Pediatric Infectious Disease Unit. Patients were studied for age, ophthalmologic examination features, laboratory and radiology results, treatment modalities, and the response to these treatments.Results: Thirty-six patients (21 males, 15 females) with an average age of 71.43±42.24 months (5-168 months) participated in the study in the two-year period. Thirty-two patients (88.9%) had preseptal cellulitis, and four (11.9%) had orbital cellulitis. All patients had eyelid hyperemia, edema, and ocular pain, with chemosis in seven and proptosis in four cases. Twenty-five patients were admitted with fever. All cases were unilateral and 44.4% occurred secondary to paranasal sinusitis. All cases were treated with intravenous cefazolin-amikacin. The mean of duration of hospitalization was 12.02±8.75 days (range, 3-28 days) and the duration of parental antibiotics was 12.83±8.18 days (range, 7-21 days). All patients recovered without any vision loss, only one patient experienced subdural empyema complicating preseptal cellulitis. Conclusions:Most orbital tissue infections occur secondary to paranasal sinusitis in childhood. Orbital tissue infections can be complicated by brain abscess, cavernous sinus thrombophlebitis, and vision loss. Early diagnosis and proper antibiotic treatment are essential to prevent these life-threatening complications.

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“…Clinical findings alone may not be specific enough to distinguish preseptal from orbital infections or those with complications. [11][12][13] To date, studies have identified proptosis and ophthalmoplegia (limitation of extraocular movements) as indicators of intraorbital inflammation but have not been able to distinguish between orbital cellulitis and abscess. [13][14][15] Laboratory findings have not proven helpful in making this determination.…”

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confidence: 99%

Acute Periorbital Infections: Who Needs Emergent Imaging?

Rudloe

Harper

Prabhu³

et al. 2010

Pediatrics

115

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WHAT'S KNOWN ON THIS SUBJECT:Orbital infections may be difficult to distinguish from periorbital cellulitis on the basis of clinical examination. CT can be used to delineate orbital anatomy and determine if an abscess is present. WHAT THIS STUDY ADDS:We present here an algorithm to stratify patients who are at risk for subperiosteal or orbital abscess and need emergent imaging, and to identify a population of patients at low risk. abstract OBJECTIVES: Computed tomography (CT) is used often in the evaluation of orbital infections to identify children who are most likely to benefit from surgical intervention. Our objective was to identify predictors for intraorbital or intracranial abscess among children who present with signs or symptoms of periorbital infection. These predictors could be used to better target patients for emergent CT. METHODS:This was a retrospective cohort study of all patients admitted to an urban pediatric tertiary care emergency department between 1995 and 2008. We included otherwise healthy patients with suspected acute clinical periorbital or orbital cellulitis without a history of craniofacial surgery, trauma, or external source of infection. Immunocompromised patients and patients with noninfectious causes of periorbital swelling were excluded. Variables analyzed included age, duration of symptoms, highest recorded temperature, previous antibiotic therapy, physical examination findings, laboratory results, and interpretation of imaging. CT scans of the orbit were reread by a neuroradiologist. RESULTS: Nine hundred eighteen patients were included; 298 underwent a CT scan, and of those, 111 were shown to have an abscess. Although proptosis, pain with external ocular movement, and ophthalmoplegia were associated with presence of an abscess, 56 (50.5%) patients with abscess did not experience these symptoms. Other variables associated with the presence of an abscess in multivariate analysis were a peripheral blood neutrophil count greater than 10 000/ L, absence of infectious conjunctivitis, periorbital edema, age greater than 3 years, and previous antibiotic therapy (P Ͻ .05 for all). Our recursive partitioning model identified all high-risk (44%) patients as well as a low-risk (0.4%-2%) group (Rsq ϭ 0.27). CONCLUSIONS: We confirmed that patients with proptosis and/or pain or limitation of extraocular movements are at high risk for intraorbital abscess, yet many do not have these predictors.

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Medical management of orbital cellulitis

Cited by 71 publications

References 9 publications

Orbital and preseptal cellulitis: a 10-year survey of hospitalized patients in a tertiary eye hospital in Iran

Orbital and preseptal cellulitis: a 10-year survey of hospitalized patients in a tertiary eye hospital in Iran

Evaluation of patients with orbital infections

Acute Periorbital Infections: Who Needs Emergent Imaging?

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