Orbital and Preseptal Infections PDF

PERIORBITAL AND ORBITAL INFECTIONS ORBITAL ANATOMY  of ORBITAL SEPTUM FIBROUS MEMBRANE SEPARATING THE ORBITAL AND PRESEPTAL COMPARTMENT UPPER EYELID EXTENDS FROM THE PERIOSTEUM OF THE ORBITAL RIM TO THE LEVATOR APONEUROSIS...

PERIORBITAL AND ORBITAL INFECTIONS ORBITAL ANATOMY  of ORBITAL SEPTUM FIBROUS MEMBRANE SEPARATING THE ORBITAL AND PRESEPTAL COMPARTMENT UPPER EYELID EXTENDS FROM THE PERIOSTEUM OF THE ORBITAL RIM TO THE LEVATOR APONEUROSIS I LOWER EYELID EXTENDS FROM THE PERIOSTEUM OF THE ORBITAL RIM TO THE INFERIOR BORDER OF THE TARSAL PLATE I ROUTES OF INFECTION EXTENSION TO LIDS AND ORBIT Fasul op blew INDIRECT SPREAD venue f ❑ ❑ D VENOUS DRAINAGE SYSTEM SHARED BY CRANIAL AND MIDFACE STRUCTURES MULTIPLE ANASTOMOSES AND VALVELESS SYSTEM ROUTES OF INFECTION EXTENSION TO LIDS AND ORBIT DIRECT SPREAD ❑ ETHMOID SINUS THROUGH LAMINA PAPYRACEA - CONTAINED SUBPEREOSTEAL ABSCESS OR PROGRESSIVE ORBITAL INVOLVEMENT ❑ FRONTAL AND MAXILLARY SINUS ❑ ORBITAL FLOOR ❑ ODONTOGENIC – MAXILLARY SINUS - ORBIT PRESEPTAL CELLULITIS ❑ AN INFECTION OR F INFLAMMATORY PROCESS OF THE EYELIDS AND PERIORBITAL STRUCTURES ❑ OCCURS ANTERIOR TO AND CONTAINED BY THE ORBITAL SEPTUM ORBITAL CELLULITIS ❑ OCCURS POSTERIOR TO THE ORBITAL SEPTUM ❑ INVOLVES THE SOFT TISSUE WITHIN THE BONY ORBIT CELLULITIS - COMMON ETIOLOGIES 1. SPREAD FROM ADJACENT STRUCTURES – SKIN AND SINUSES On 2. DIRECT INOCULATION FOLLOWING TRAUMA 3. BACTERIAL SPREAD UPPER RESPIRATORY OR MIDDLE EAR PRESEPTAL – ASSOCIATED FACTORS I bet HORDEOLA AND CHALAZIA Eyelid swelling both causes and IMPETIGO/ERYSIPELAS results from impeded venous flow BLEPHARITIS and lymphatic drainage – leading to CONJUNCTIVITIS self-propagating process CANALICULITIS DACRYOCYSTITIS VIRAL DERMATITIS – HERPES SIMPLEX & HERPES ZOSTER CHALAZION chami i.is MOST COMMON INFLAMMATORY LESION OF EYELID c BLOCKED MEIBOMIAN GLAND INFLAMMATORY NODULE/CYST LIPOGRANULOMATOUS NOT INFECTIOUS TYPICALLY NOT PAINFUL NFections CHALAZION MANAGED BY WARM COMPRESSES AND MASSAGE EXCISION/ STEROID INJECTION CHALAZION PREVENTION ROUTINE USE OF WARM COMPRESSES LID MARGIN CLEANSING LOW DOSE ORAL DOXYCYCLINE ERYSIPELAS SUPERFICIAL CELLULITIS USUALLY GROUP A STREP INTENSELY ERYTHEMATOUS WITH SHARPLY DEMARCATED BORDER.An external hordeolum represents a localized abscess formation of the follicle of an eyelash whereas an internal hordeolum is an acute bacterial infection of the meibomian glands of the eyelid. HORDEOLUM BACTERIAL INFECTION MEBOMIAN GLAND OR CILIARY GLANDS (ZEISS OR MOLL) INTERNAL OR EXTERNAL TYPICALLY PAINFUL MAY LEAD TO PRESEPTAL CELLULITS  HORDEOLUM MANAGEMENT STAPHYLOCOCCAL - MOST COMMON ETIOLOGY SYSTEMIC ANTIBIOTICS LANCE/DRAIN 1484 1010 9 DACRYOCYSTITIS Info PAIN, REDNESS AND SWELLING BELOW THE MEDIAL CANTHAL TENDON TYPICALLY ASSOCIATED WITH BLOCKAGE OF THE NASOLACRIMAL SYSTEM TEAR STASIS AND RETENTION → SECONDARY BACTERIAL INFECTION  DACRYOCYSTITIS MANAGEMENT ANTIBIOTICS – SYSTEMIC WARM COMPRESSES DRAINAGE  DACRYOCYSTITIS MANAGEMENT ORAL ANTIBIOTICS GRAM POSITIVE BACTERIA MOST COMMON 0 CONSIDER GRAM NEG IN DIABETICS, IMMUNOCOMPROMISED PATIENTS IV ANTIBIOTICS WHEN SEVERE/ASSOCIATED WITH ORBITAL CELLULITIS DRAINAGE OF ABSCESS HERPES ZOSTER DERMATOBLEPHARITITS 7 RECURRENCE OR REACTIVATION OF VARICELLA ZOSTER VIRUS BURNING, STABBING PAIN OF FOREHEAD/SCALP VESICULAR RASH IN V1 DISTRIBUTION HERPES ZOSTER DERMATOBLEPHARITITS TREAT TREAT WITH WITH ANTIVIRALS ANTIVIRALS ACYCLOVIR A ONSET ONSET e CYCLOVIR IF IF IDENTIFIED IDENTIFIED WITHIN 72 HOURS WITHIN 72 HOURS OF OF SKIN SKIN LESION LESION PRESEPTAL CELLULITIS OTHER CAUSES OF EYELID SWELLING CONTACT DERMATITIS INSECT BITES THYROID EYE DISEASE DACRYOADENITIS PRESEPTAL CELLULITIS eczema OTHER CAUSES OF EYELID SWELLING CONTACT DERMATITIS THICKENED, ERYTHEMATOUS, SCALY SKIN PRESEPTAL CELLULITIS OTHER CAUSES OF EYELID SWELLING INSECT BITES 0 PRESEPTAL CELLULITIS OTHER CAUSES OF EYELID SWELLING THYROID EYE DISEASE PERIORBITAL EDEMA e PRESEPTAL CELLULITIS OTHER CAUSES OF EYELID SWELLING DACRYOADENITIS INFLAMMATION OF LACRIMAL GLAND SUPEROTMEPORAL PAIN, SWELLING, ERYTHEMA “S” SHAPED LID DEFORMITY PRESEPTAL MANAGEMENT TYPICALLY OUTPATIENT =ORAL ANTIBIOTICS ALL CHILDREN < 1 YEAR OLD SHOULD BE HOSPITALIZED WITH IV ANTIBIOTICS 50 CULTURE WHEN ABLE – MORE LIKELY AFTER TRAUMATIC INSULT MOST COMMON BACTERIA INVOLVED FOR ADULTS: STAPH AURUES AND STREP PYOGENES MOST COMMON FOR CHILDREN: H INFLUENZA TYPE B AND STREP PNEUMONIA IF ABSCESS DEVELOPS IT SHOULD BE INCISED AND DRAINED PRESEPTAL MANAGEMENT TEENAGERS AND ADULTS USUALLY ARISES FROM SUPERFICIAL SOURCE (TRAUMA, CHALAZION) TREATED WITH ORAL ANTIBIOTICS COMMONLY PENICILLINASE-RESISTANT PENICILLIN OR BACTRIM IMAGE IF: SOURCE OF INFECTION NOT DETERMINED NOT RESPONDING QUICKLY TO TREATMENT ORBITAL PROCESS SUSPECTED PRESEPTAL MANAGEMENT CHILDREN THE MOST COMMON CAUSE IS UNDERLYING SINUSITIS WORK UP WITH CT QUICKLY IF NO SOURCE OF DIRECT INOCULATION EASILY IDENTIFIED HOSPITALIZE AND IV ANTIBIOTICS ORBITAL CELLULITIS OPHTHALMIC SIGNS PROPTOSIS Fee MOTILITY DISTURBANCE PRONOUNCED EDEMA AND ERYTHEMA IMPAIRED VISION WITH AFFERENT PUPIL DEFECT CONJUNCTIVAL CHEMOSIS AND HYPEREMIA REDUCED CORNEAL SENSATION ORBITAL CELLULITIS SOURCES OF INFECTION ARE SIMILAR TO PRESEPTAL EXTENSION OF SINUS DISEASE PENETRATING TRAUMA INFECTED ADJACENT STRUCTURES OTHER UNCOMMON SOURCES c SCLERAL BUCKLES, AQUEOUS DRAINAGE DEVICES, ENDOPHTHALMITIS ORBITAL CELLULITIS > 90% OF ALL RELATED TO UNDERLYING SINUS DISEASE IN CHILDREN USUALLY SINGLE ORGANISM FROM SINUS (S AUREUS OR STREP PNEUMONIA) ADOLESCENTS AND ADULTS HAVE MORE COMPLEX BACTERIOLOGY (OFTEN 2-5 ORGANISMS) TRAUMA – GRAM - RODS DENTAL – MIXED, AGGRESSIVE AEROBES AND ANAEROBES I IMMUNOCOMPROMISED/DIABETICS - FUNGI ORBITAL CELLULITIS LABORATORY STUDIES CBC BLOOD CULTURES cog NASAL SWAB IF PURULENT MATERIAL LUMBAR PUNCTURE IF MENINGEAL SIGNS PRESENT c ORBITAL CELLULITIS IMAGING STUDIES ORBITAL CT THIN, AXIAL AND CORONAL, WITHOUT CONTRAST INCLUDE ORBITS, PARANASAL SINUSES, FRONTAL LOBES IF NEUROLOGIC INVOLVEMENT INCLUDE THE HEAD WHEN IMAGING ORBITAL CELLULITIS MEDICAL MANAGEMENT ADMIT FOR IV ANTIBIOTICS CEPHALOSPORIN I– AMPICILLIN OR PIPERCILLIN VANCOMYCIN FOR MRSA CLINDAMYCIN FOR ANAEROBIC COVERAGE NASAL DECONGESTANTS TRANSITION TO OUTPATIENT ORAL ANTIBIOTICS TREATMENT FOR 1-3 WEEKS ORBITAL CELLULITIS SURGICAL MANAGEMENT IF ORBITAL ABSCESS PRESENT EARLY DRAINAGE OF INVOLVED SINUS IF ORBITAL SIGNS PROGRESSING ORBITAL CELLULITIS SIGNIFICANT MORBIDITY IF NOT APPROPRIATELY TREATED ORBITAL APEX SYNDROME BLINDNESS CAVERNOUS SINUS THROMBOSIS 5 CRANIAL NERVE PALSIES MENINGITIS INTRACRANIAL ABSCESS  DIFFERENTIATING FEATURES OF CELLULITIS 0 Feature Preseptal Orbital Proptosis Absent G Present Motility Normal - pain Decreased + pain and double vision Vision Normal Reduced – check vision and color vision Pupillary Reaction Normal +/- APD – check swinging flashlight test Chemosis Rare Common Corneal Sensation Normal May be reduced Systemic Signs Absent/Mild Commonly severe (Fever/ Leukocytosis) ORBITAL CELLULITIS L NONINFECTIOUS CAUSES OF ORBITAL INFLAMMATORY DISEASE INFLAMMATORY AND AUTOIMMUNE THYROID OPHTHALMOPATHY ORBITAL PSEUDOTUMOR LYMPHOMA DERMATOMYOSITIS-POLYMYOSITIS ORBITAL CELLULITIS NONINFECTIOUS CAUSES OF ORBITAL INFLAMMATORY DISEASE VASCULAR a ORBITAL VENOUS MALFORMATION CAVERNOUS SINUS THROMBOSIS ARTERIOVENOUS FISTULA ORBITAL CELLULITIS NONINFECTIOUS CAUSES OF ORBITAL INFLAMMATORY DISEASE NEOPLASMS OF ORBIT AND LACRIMAL GLAND PEDIATRIC: RHABDOMYOSARCOMA, LEUKEMIA, METASTATIC NEUROBLASTOMA, RETINOBLASTOMA ADULT: LYMPHOMA