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{{Orbital cellulitis}}
{{Orbital cellulitis}}
==Overview==
==Overview==
Patients with orbital cellulitis usually appear ill. Physical examination of patients with orbital cellulitis is usually remarkable for [[fever]], [[proptosis]], [[ophthalmoplegia]], and impaired [[visual acuity]]. Patients should undergo a complete [[physical examination]], paying particular attention to [[general appearance]], [[vital signs]], [[visual acuity]], [[visual field]], orbital positioning, ocular movmements, [[oropharynx]], and [[nasopharynx]] examinations.<br>
Patients with orbital cellulitis usually appear ill. Physical examination of patients with orbital cellulitis is usually remarkable for [[fever]], [[proptosis]], [[ophthalmoplegia]], and impaired [[visual acuity]]. Patients should undergo a complete [[physical examination]], paying particular attention to [[general appearance]], [[vital signs]], [[visual acuity]], [[visual field]], orbital positioning, ocular movmements, [[oropharynx]], and [[nasopharynx]] examinations.<ref name=Eyewikiorbitalcellulitis>American Academy of Ophthalmology EyeWiki (2015)http://eyewiki.aao.org/Orbital_Cellulitis</ref><ref name=orbitalcellulitiisstanford>Stanford Orbital Cellulitis Summary (2011)http://peds.stanford.edu/Rotations/blue_team/documents/Periorbital_and_Orbital_Cellulitis_Summary.pdf</ref><ref name="pmid22224014">{{cite journal| author=Lam Choi VB, Yuen HK, Biswas J, Yanoff M| title=Update in pathological diagnosis of orbital infections and inflammations. | journal=Middle East Afr J Ophthalmol | year= 2011 | volume= 18 | issue= 4 | pages= 268-76 | pmid=22224014 | doi=10.4103/0974-9233.90127 | pmc=3249811 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22224014  }} </ref><ref name="pmid22346113">{{cite journal| author=Chaudhry IA, Al-Rashed W, Arat YO| title=The hot orbit: orbital cellulitis. | journal=Middle East Afr J Ophthalmol | year= 2012 | volume= 19 | issue= 1 | pages= 34-42 | pmid=22346113 | doi=10.4103/0974-9233.92114 | pmc=3277022 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22346113  }} </ref><ref name="pmid15318671">{{cite journal| author=Hasanee K, Sharma S| title=Ophthaproblem. Orbital cellulitis. | journal=Can Fam Physician | year= 2004 | volume= 50 | issue=  | pages= 359, 365, 367 | pmid=15318671 | doi= | pmc=2214559 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15318671  }} </ref><br>


==Physical Examination==
==Physical Examination==
Patients with orbital cellulitis usually appear ill. Physical examination of patients with orbital cellulitis is usually remarkable for [[fever]], [[proptosis]], [[ophthalmoplegia]], and impaired [[visual acuity]].The physical examination should assess:(EYE WIKI)
Patients with orbital cellulitis usually appear ill. Physical examination of patients with orbital cellulitis is usually remarkable for [[fever]], [[proptosis]], [[ophthalmoplegia]], and impaired [[visual acuity]].The physical examination should assess:<ref name=Eyewikiorbitalcellulitis>American Academy of Ophthalmology EyeWiki (2015)http://eyewiki.aao.org/Orbital_Cellulitis</ref>
*Vital signs
*Vital signs
*Best-corrected visual acuity(BCVA)
*Best-corrected visual acuity(BCVA)
Line 23: Line 23:


==Signs==
==Signs==
After a complete and thorough physical examination, patients with orbital cellulitis may present with some or all of the following signs:
After a complete and thorough physical examination, patients with orbital cellulitis may present with some or all of the following signs<ref name=Eyewikiorbitalcellulitis>American Academy of Ophthalmology EyeWiki (2015)http://eyewiki.aao.org/Orbital_Cellulitis</ref><ref name=orbitalcellulitiisstanford>Stanford Orbital Cellulitis Summary (2011)http://peds.stanford.edu/Rotations/blue_team/documents/Periorbital_and_Orbital_Cellulitis_Summary.pdf</ref><ref name="pmid22224014">{{cite journal| author=Lam Choi VB, Yuen HK, Biswas J, Yanoff M| title=Update in pathological diagnosis of orbital infections and inflammations. | journal=Middle East Afr J Ophthalmol | year= 2011 | volume= 18 | issue= 4 | pages= 268-76 | pmid=22224014 | doi=10.4103/0974-9233.90127 | pmc=3249811 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22224014  }} </ref><ref name="pmid22346113">{{cite journal| author=Chaudhry IA, Al-Rashed W, Arat YO| title=The hot orbit: orbital cellulitis. | journal=Middle East Afr J Ophthalmol | year= 2012 | volume= 19 | issue= 1 | pages= 34-42 | pmid=22346113 | doi=10.4103/0974-9233.92114 | pmc=3277022 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22346113  }} </ref><ref name="pmid15318671">{{cite journal| author=Hasanee K, Sharma S| title=Ophthaproblem. Orbital cellulitis. | journal=Can Fam Physician | year= 2004 | volume= 50 | issue=  | pages= 359, 365, 367 | pmid=15318671 | doi= | pmc=2214559 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15318671  }} </ref>:
===General Appearance===
===General Appearance===
Patients with orbital cellulitis usually appear ill and have marked inflammation and edema of the periorbital area.
Patients with orbital cellulitis usually appear ill and have marked inflammation and edema of the periorbital area.

Revision as of 22:30, 24 July 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [2]

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Overview

Patients with orbital cellulitis usually appear ill. Physical examination of patients with orbital cellulitis is usually remarkable for fever, proptosis, ophthalmoplegia, and impaired visual acuity. Patients should undergo a complete physical examination, paying particular attention to general appearance, vital signs, visual acuity, visual field, orbital positioning, ocular movmements, oropharynx, and nasopharynx examinations.[1][2][3][4][5]

Physical Examination

Patients with orbital cellulitis usually appear ill. Physical examination of patients with orbital cellulitis is usually remarkable for fever, proptosis, ophthalmoplegia, and impaired visual acuity.The physical examination should assess:[1]

  • Vital signs
  • Best-corrected visual acuity(BCVA)
  • Color vision assessment
  • Proptosis measurements using Hertel exophthalmometry
  • Visual field assessment
  • Assessment of pupillary function with particular attention paid to the presence of a relative afferent pupillary defect(rAPD)
  • Ocular motility and presence of pain with eye movements.Also, there might be involvement of the III, IV, and VI cranial nerve in cases of cavernous sinus involvement
  • Orbit exam should include documentation of direction of displacement of globe
  • Measurement of intraocular pressure (IOP)
  • Slit-lamp test in cases of severe proptosis
  • Dilated fundus exam to exclude optic neuropathy or retinal vascular occlusion.
  • Nasal sinus examination
  • Otoscopy for presence of otitis media
  • Oral examination for oropharyngeal infection and dentition

Signs

After a complete and thorough physical examination, patients with orbital cellulitis may present with some or all of the following signs[1][2][3][4][5]:

General Appearance

Patients with orbital cellulitis usually appear ill and have marked inflammation and edema of the periorbital area.

Vital Signs

Patients with orbital cellulitis may have the following vital signs:

Skin

Patients with orbital cellulitis usually have the following skin findings:

  • Erythema of the periorbital skin and eyelid
  • Edema of the periorbital skin and eyelid

HEENT

Patients with orbital cellulitis may have the following HEENT findings on physical examination:

Head

Patients with orbital cellulitis may present with the following signs:

  • Evidence of recent orbital or head trauma or surgery (e.g. scars, injuries, etc.)
  • Evidence of recent insect bites

Eyes

Patients with orbital cellulitis may present with some or all the following signs:

  • Periorbital edema and erythema
  • Proptosis
  • Ophthalmoplegia
  • Restricted or painful ocular movements
  • Reduced visual acuity
  • Increased intraocular pressure (IOP)
  • Displacement of the globe
  • Diminished visual field
  • Signs of orbital trauma, or periorbital surgery (scars, injuries)
  • Signs of periorbital insect bites

Ear

Patients with orbital cellulitis may present with signs of inner or middle ear infection:

  • Erythema, edema and discharge present on otoscopy
  • Reduced hearing
  • Children may show signs of "tugging" on the affected ear

Nose

Patients with orbital cellulitis may present with:

Throat/Oral

Patients with orbital cellulitis may present with

Neck

Patients with orbital cellulitis may present with tender cervical lymph nodes.

Lung

Patients with orbital cellulitis may present wheezing or coughing, indicating upper respiratory tract infection.

References

  1. ↑ 1.0 1.1 1.2 American Academy of Ophthalmology EyeWiki (2015)http://eyewiki.aao.org/Orbital_Cellulitis
  2. ↑ 2.0 2.1 Stanford Orbital Cellulitis Summary (2011)http://peds.stanford.edu/Rotations/blue_team/documents/Periorbital_and_Orbital_Cellulitis_Summary.pdf
  3. ↑ 3.0 3.1 Lam Choi VB, Yuen HK, Biswas J, Yanoff M (2011). "Update in pathological diagnosis of orbital infections and inflammations". Middle East Afr J Ophthalmol. 18 (4): 268–76. doi:10.4103/0974-9233.90127. PMC 3249811. PMID 22224014.
  4. ↑ 4.0 4.1 Chaudhry IA, Al-Rashed W, Arat YO (2012). "The hot orbit: orbital cellulitis". Middle East Afr J Ophthalmol. 19 (1): 34–42. doi:10.4103/0974-9233.92114. PMC 3277022. PMID 22346113.
  5. ↑ 5.0 5.1 Hasanee K, Sharma S (2004). "Ophthaproblem. Orbital cellulitis". Can Fam Physician. 50: 359, 365, 367. PMC 2214559. PMID 15318671.

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