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Clin Med 207: Orbit
| Question | Answer |
|---|---|
| Is preseptal cellulitis an orbital disease? | No! |
| Painful, swollen and infected lacrimal sac and/or drainage system | Darcyocystitis |
| Treatment of dacryocystitis | Oral antibiotics with a prophylactic topical antibiotic. Give hot compresses. DO NOT LANCE! |
| Herpes Zoster usually affects the _______ lid | Upper lid |
| Signs and Symptoms of Preseptal Cellulitis | Mild orbital edema (usually upper lid), unilateral, warmth of lid, redness, quiet conj, chemosis of lid |
| Signs and Symptoms of Orbital Cellulitis | Same as preseptal EXCEPT with proptosis, EOM restrictions, pain on eye movement, red eye, decreased acuity and fever/HA |
| An "s-shaped" inflammation of the upper lid is associated with __________ | Preseptal Cellulitis |
| How do you treat a preseptal cellulitis? | Keflex, Ceclor (cephalosporins), Augmentin, Erythromycin (for penicillin/sulfa allergy). Topical and oral decongestants should be used for comfort. |
| When should a patient return to your office after being diagnosed with preseptal cellulitis? | 24 hours |
| Preseptal cellulitis is most common in what age group? | Children |
| How long after initial insult does preseptal cellulitis occur? | 24-48 hours |
| An infection within the retrobulbar tissues of the orbit | Orbital Cellulitis |
| Should you try to treat an orbital cellulitis in the office? | NO!! Send to ER for IV antibiotics (cross BBB) |
| #1 Cause of orbital and preseptal cellulitis | Direct extension of a sinus infection |
| Most common organism involved in orbital cellulitis | Staph Aureus and Strep |
| 3 P's of Orbital Cellulitis | Proptosis, external ophthalmoPlegia, Pain |
| Progression of cellulitis | Preseptal --> Periorbital Cellulitis --> Orbital cellulitis --> sub-periosteal abscess --> orbital abscess --> Cavernous Sinus Thrombosis |
| Spread of infection of the orbital cellulitis by means of vascular emissaria to the cavernous sinus | Cavernous Sinus Thrombosis |
| Malaise, fever, lid injection, progressive proptosis, chemosis, rising IOP, and papilledema | Cavernous Sinus Thrombosis |
| Ocular signs of cavernous sinus thrombosis include _______ and __________ | Purple lid skin and severe congestion of venous system (ONH edema) AND BILATERALITY!! |
| Rare aggressive life-threatening orbital fungal infection | Mucormycosis |
| Mucormycosis is commonly seen in which pts? | DM, transplant, immuno-compromised |
| Treatment of Mucormycosis involves | Ketoconazole, Immediate hospitalization, IV Amphotericin B |
| Black eschar (ischemic infarction and septic necrosis) is an important finding in which condition? | Mucormycosis |
| Mortality rate of Orbital Cellulitis with Mucormycosis | 30% |
| Non-neoplastic, noninfectious space-occupying periocular lesion. Usually unilovar with no identifiable cause. | Idiopathic Orbital Inflammation |
| Peak incidence of orbital inflammatory pseudotumor | Middle Age |
| Systemic signs of orbital inflammatory pseudotumor | Malaise and distress |
| Describe the orbital CT scan in orbital inflammatory pseudotumor | Sinuses are normal |
| Describe the orbital CT Scan in orbital cellulitis | Sinuses full of infectious material |
| Treatment for orbital inflammatory pseudotumor | Trial of steroid therapy (60-100 mg po qd for 2-4 weeks, with tapering dose over several months). Also use anti-ulcer medication. |
| Clinical presentation of orbital tumor | Proptosis, palpable mass, displacement of globe, resistance of repulsion of flobe, decreased VA, optic nerve swelling, retinal congestion, choroidal folds |
Created by:
LaurenLofdahl
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