Orbit/Oculoplastic Quiz 3: Infection
Figures 1-2. 54 year old man with 4 days of progressively worsening pain and swelling around the right eye.
|Questions and Answers|
|1. What is the differential diagnosis?|
Answer: Preseptal cellulitis, orbital cellulitis, pseudotumor, malignancy, trauma.
2. What is the classification scheme for orbital infectious processes?
Answer: A) Preseptal cellulitis. B)Orbital cellulitis. C) Subperiosteal abscess. D)Orbital abscess. E)Cavernous sinus thrombosis. Note: these are independent categories and do not necessarily represent chain of progression of disease.
3. In what age GROUP is preseptal cellulitis most commonly seen?
Answer: Pediatric. A vast majority of patients (around 80%) are less than 20 years old.
4. What diagnostic modalitis are indicated in the work-up of the above pictured patient?
Answer: Complete ophthalmic examination, including cranial nerve testing, color vision testing and ocular motility testing. Additionally; CT scanning, blood cultures and wound cultures should be obtained. Lumbar puncture may be required if meningeal signs are present.
5. How should this patient be treated?
Answer: Broad-spectrum intravenous antibiotics are indicated in such severe cases. Oral antibiotics may suffice in less severe infections. Abscesses require surgical drainage for complete resolution.