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Clin Med 207: Orbit

QuestionAnswer
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