Morning Report: Eye Infections

Here’s Dr. Alsup with today’s Morning Report!

Eye Infections

Orbital septum

-Connective tissue extension of the orbital periosteum

-Extends into the upper and lower eyelids

Periorbital / Preseptal

• Average age: 2 yo
• Result of local trauma, including insect bites
• Spread from contiguous structures, as in conjunctivitis, hordeolum, lacrimal system infections, and impetigo
• Associated with periorbital edema

Orbital

• Usually an extension of a sinus infection into the orbit behind the septum
• Average age of presentation is 12 years old
• Infections secondary to hematogenous spread during bacteremia due to nasopharyngeal pathogens
• Sinusitis, dental trauma
• Complications include sub-periosteal abscess, orbital abscess, cavernous sinusthrombosis, panophthalmitis, or endophthalmitis.

Microbiology

• S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus, S. pyogenes, and anaerobic upper respiratory flora such as Bacteroides and Fusobacterium species.

To CT or not?

• Painful eye movements
• Inability to perform a full evaluation of the eye due to edema
• Proptosis
• Ophthalmoplegia
• Decreased visual acuity or color vision
• Bilateral periorbital edema

DX:

• Plain radiographs—- crap
• CT orbit
• Ultrasound?

Dispo:

• Preseptal- most go home, unless unresponsive to po abx
• Orbital- admission!

Abx:

Cefuroxime or Ampicillin-sulbactam +/- Clindamycin and Vanco

References:

• I-Ting Preseptal and Orbital Cellulitis: A 10-Year Review of Hospitalized Patients. J Chin Med Assoc • September 2006 • Vol 69 • No 9
• http://emedicine.medscape.com/article/798397-overview
• Bedside ultrasound in the diagnosis of orbital cellulitis and orbital abscessCharlotte Derr, Ankit Shah. Emergency Radiology. June 2012, Volume 19, Issue 3, pp 265-267
• Tintinalli’s Emergency Medicine Chapter 115

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• Bio
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Jay Khadpe MD

• Editor in Chief of "The Original Kings of County"
• Assistant Professor of Emergency Medicine
• Assistant Residency Director
• SUNY Downstate / Kings County Hospital

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