Orbital Cellulitis an ocular emergency!


hey guys Katelyn here and for this week’s
YouTube video I wanted to talk all about orbital cellulitis I had a good case of
this a couple weeks ago and it reminded me that I haven’t had a case like this
in a good bit so I thought it’d be a good time to review it there’s many
different, differentials of infections around the eye the common one that we
know well is pink eye or conjunctivitis they can be viral or bacterial there’s
also infections of the eyelid you can have preseptal cellulitis you can
have a dacryoadenitis, dacryocystitis and I like to classify a lot of these as
pre preseptal cellulitis but the differentials and the treatment
are all different so I wanted to do a review of this and then mainly focus
on orbital cellulitis and the dangerous reasons that we classify this as an
ocular emergency so let’s get started so like I was talking about before there’s
a lot of differential diagnoses for infections in and around the eye we can
start with the least dangerous um the stye or something a bump on top of the
eye that looks like a sty there’s two differentials but I like to go over with
this one if it’s painful and they have a bump and the patient’s really irritated
when you touch it that is a horny olam and that is an infection of one of the
ducts in your eye and then it’s not painful and it’s a Bop and they’re
moving it around the patient goes it’s not pink well it’s just annoying that
it’s there that is a blocked mabu being gland and I just called a Khaleesi on
and then you might have infections of the eyelid so both upper and lower
eyelids or just one will be erythema Dez there might be a little crusting a
little drainage on them and all three of these the mainstay of
treatment is just warm compresses up to four times a day a lot of times I will
tag on or either myocin ointment to add and then to microbial factor and a
lubricating factor and prevent further infection it’s not needed the mainstay
of treatment is those warm presses and you really have to push the
patient to do a lot of warm compresses because there’s ago I did it once why
isn’t working yeah you have to do a lot so then you can have infections of the
lacrimal gland where you make tears and then the drainage doctor down into the
corner of the eye the lacrimal system it’s up here it’s called Decker a
tinnitus and it’s down here it’s called Decker assist itis and you will have a
lot of localised redness swelling in those areas and if you have either one
of those infections then you need to put these patients on oral antibiotics and
then a step up from that is going to be the precept of cellulitis so not the
orbital cellulitis the precept of cellulitis and this is their entire eye
is going to be red and there might be a little bit of a diamond there might be a
little bit of drainage on the skin surrounding the eye the eye itself the
conjunctiva can be a little injected in the little erythema might have a little
drainage from the eye and again the mainstay treatment for this is going to
be oral antibiotics and then when it gets dangerous is when it becomes
orbital cellulitis so this is infections behind that septum that I keep
mentioning so with this there you might have some of the same benefit stations
of precept though cellulitis but with orbital cellulitis you might
have vision changes with the eye anything at all double vision a little
specks anything at all so I’m just going to be so acuity on these patients they
may have some proptosis for the eye so I might be coming out a little bit at you
and you see this Graves disease sometimes and then lastly you might have
pain with extra ocular movements so if you have any of these symptoms and that
is concerning for orbital cellulitis so as you can see here this is the erythema
and EEMA you might see with periorbital cellulitis and also with orbital
cellulitis but the orbital cellulitis is obviously going to have the pain with
excellent eye movements proptosis and any type of vision changes now as you
can see here this is a good diagram of all the sinuses that surround the
I sang situs is one of the most common causes of orbital cellulitis
but ethmoid sinus itis is the absolute most common cause so far throughout this
video I have referred to pre septal and post septal orbital cellulitis so this
is the septum that I am referring to so any kind of infection that is pre septal
is going to be on the outside more along the skin and post septum is an infection
of anything behind the septum here so that’s why it causes a little more pain
with extra eye movements that’s why the I can pop out and that’s why you can
also have vision changes so if you are ever worried about oh no cellulitis so
again those three symptoms that I like to think about our proper ptosis of the
eye any pain with extra ocular movements or any visual changes at all you are
gonna want to order a orbital CT of the post septal area looking for signs of
infection my guy my patient weeks ago came in he self diagnosed himself with
conjunctivitis good guy and it was using at home
antibiotic jobs that were left over from the previous conjunctivitis he said it
wasn’t getting any better and the itching was worse and he said he thinks
from the itching and the skin tears he got from it for you disposed him to the
infection he eventually got around the eye as well not at that point he went to
an urgent care and then they called over and said hey we’re sending them to us to
rule out overdose cellulitis so in the emergency department he definitely had
pre septal cellulitis it was erythema de it was a little doughnuts he didn’t have
any appraoch doses didn’t have any vision changes and he didn’t have any
visual changes his visual acuity is great on both sides but he did have pain
with a stronger eye movements I’m only with looking in the upward case it was a
soft call but we got the orbital CT he didn’t have orbital cellulitis he just
had pre septal cellulitis we added an oral antibiotic actually two of them to
his regimen and told him to continue to do eyedrops to his eye because he still
had conjunctivitis as well and we sit him home and he ended up doing
okay so when it comes to the treatment of orbital cellulitis
again this is an ocular emergency so you are going to want to start treatment as
soon as possible and the treatment is IV antibiotics so these patients need to be
admitted into the hospital and again it’s not camera to see so you’re gonna
want to start IV antibiotics as soon as possible in the emergency department
most of the things that infect the eye are grand positive so you start with IV
Vanco myosin and then a research has shown to add another gram negative
coverage so a lot of broad spectrum coverage and treating this disease
because the main complication is vision loss so IV Vanco myosin you can do plus
zosyn that’s what I usually do plus ampicillin plus ceftriaxone and if your
patient is immunocompromised many buddies or they’re a diabetic consider
the chance for a fungal infection and get cultures of the eye and possibly
start them on a boat Arison and that’s it guys thanks for listening I know it’s
been a second since we’ve done a YouTube video it’s been the holidays and I hope
you like to enjoy your time off if you’re interested in me my previous
youtube videos the last one I did was a roundabout way to talk about d-dimer’s
and when to order them and then I went into specific patient populations and
where d-dimer’s are more useful and different threshold
cut-offs from there so go take a look at that see you next week guys

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