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Periorbital Cellulitis - Causes, Symptoms and Treatment


Definition

Periorbital cellulitis is an inflammation and infection of the eyelid and the skin surrounding the eye. It is usually caused by an infection spreading from the membrane covering the outer part of the eye. It is infection of the eyelid and surrounding skin anterior to the orbital septum. Either can be caused by an external focus of infection e.g. a wound infection that extends from the nasal sinuses or teeth, or metastatic spread from infection elsewhere. Although rarely associated with complications, any infection near the eye and close to the brain is potentially serious. It is important to consult a physician immediately if you think that you or your child may have periorbital cellulitis. It usually affects only one eye and doesn't travel to the other. Your baby won't be able to tell you if his eye hurts, but if his eyelid is swollen and red, call his doctor right away.

Causes

  1. Infections that spread from areas around the eyes. These may be sinus which is the most common reason or mouth and teeth or face.
  2. Children are at high risk of severe infections from orbital cellulites that could result in blindness.
  3. The reason may be an injury. There are a lot of chances when an injury after getting infection may convert into periorbital cellulitis.
  4. The biting of a bug may also cause periorbital cellulitis.
  5. Beta-hemolytic streptococci also cause this disease.
  6. Infections that spread from the bloodstream can also cause this disease.

Symptoms

  1. Orbital cellulitis include swelling and redness of the eyelid and surrounding soft tissues, conjunctival hyperemia and chemosis, decreased ocular motility, pain with eye movements, decreased visual acuity and exophthalmos caused by orbital swelling.
  2. There may be eye tearing and you may have blurred vision.
  3. You may have a fever or a runny nose.
  4. Subperiosteal abscesses, if large enough, can cause swelling and redness of the eyelid, decreased ocular motility, exophthalmos, and decreased visual acuity.
  5. Inflammation of the epiglottis i.e. the cartilage flap that covers the opening of the windpipe during swallowing may occur.
  6. Loss of vision is also a major symptom in this disease.

Treatment

  1. In adult patients who are nontoxic and can be assured of appropriate follow-up mostly antibiotics are given.
  2. The treatment of blepharitis, regardless of etiology, begins with eyelid hygiene. The patient should be instructed to wash the lids with a nonirritating babyshampoo or a commercially prepared lid scrubbing solution and to use warm compresses for 15 minutes at a time, 3 or 4 times a day.
  3. Patients with orbital cellulitis should be hospitalized and treated with meningitis-dose antibiotics.
  4. Trauma related- Gram positive coverage with Cephalexin, Augmentin, Dicloxacillin, or Clindamycin If the child is not toxic appearing may treat orally with careful follow-up.
  5. Some children can be tried on IV antibiotics including Clindamycin and Ceftriaxone initially and reassessed in 24 hours with repeat CT.
  6. Surgery to decompress the orbit and open infected sinuses is indicated if vision is compromised or suppuration or foreign body is suspected
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