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Orbit/Oculoplastic Quiz 3: Infection
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David Zacks, MD/PhD | Massachusetts Eye and Ear Infirmary, Harvard Medical School

November 29, 1997
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Figure 1
Figures 1-2. 54 year old man with 4 days of progressively worsening pain and swelling around the right eye.
Figure 2
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.

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