Orbital Cellulitis

Clinical Description

This is an ophthalmic emergency. Risk factors include sinus disease, traumatic orbital septal perforation, and post orbital surgery

Signs and Symptoms

• fever, periocular pain, inflamed eye lids, proptosis, restricted and painful extraocular movements, poor visual acuity, RAPD, reduced color vision

Investigations

• FBC, BC, CSF analysis if meningeal or cerebral signs develop
• CT scan of the orbits, paranasal sinuses and brain

Treatment

• Hospital admission
• ENT assessment is mandatory.
• Antimicrobial therapy
• Ceftazidime 1g IV 8hourly and Metronidazole 500mg IV 8hourly. Therapy should be continued until the patient is apyrexial for 4 days.
• Optic nerve function monitoring
• Visual acuity, colour vision, pupillary reactions, and light brightness appreciation.
• Surgical intervention should be considered in orbital or subperiosteal abscesses, unresponsiveness to antibiotics and in decreasing vision.