OP2.4 | Orbital Cellulitis — Summary & Reflection

KEY TAKEAWAYS

Orbital cellulitis is a postseptal infection — distinguished from preseptal cellulitis by proptosis, restricted and painful EOM, and possible vision reduction. Commonest source in children is ethmoid sinusitis via the thin lamina papyracea. Chandler's classification stages from I (preseptal oedema) through II (orbital cellulitis) to III (subperiosteal abscess, most often medial) to IV (orbital abscess) to V (cavernous sinus thrombosis — bilateral signs). Investigation: CT orbits mandatory; blood cultures; FBC; glucose. Management: IV co-amoxiclav from diagnosis; surgical drainage for abscess, failure to improve in 48 hours, or any vision change. Monitor VA and colour vision every 12 hours — any drop demands immediate CT and surgical review. Complications: compressive optic neuropathy, CRAO, cavernous sinus thrombosis, and intracranial abscess. Mucormycosis is a special emergency in diabetics and immunocompromised patients requiring radical debridement and IV liposomal amphotericin B.

REFLECT

Orbital cellulitis tests your ability to act decisively under pressure. Reflect on the sequence of decisions you would make in the first two hours of seeing the 10-year-old from the hook scenario — what clinical examination data are you gathering while also calling the CT technician and the ENT registrar? How would you explain to the child's parents that he might need an operation tonight? Think also about the Mucormycosis scenario — what would you do if you had a 55-year-old diabetic with poorly controlled blood glucose, right orbital cellulitis, and a small black area on the right side of his nasal septum when you examine him? What makes that scenario different from standard bacterial orbital cellulitis?