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Question: Eye

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Which of the following helps to differentiate periorbital (preseptal) cellulitis from orbital cellulitis?
IDOphtho

pemsou5_wp • September 17, 2019


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  1. Kelly September 18, 2019 - 11:49 pm Reply

    D) Pain on extraocular movements
    Periorbital (preseptal) cellulitis is infection confined to tissue anterior to the orbital septum, is more common in children < 5 years old, and can result from local skin trauma, spread from sinusitis, or hematogenous spread. Orbital cellulitis, infection posterior to the septum, is more common in older children, has a slight male predominance, and most often spreads from sinusitis. Staph and strep predominate in both. Both can present with a painful red swollen eyelid, sometimes swollen shut, and systemic symptoms. Proptosis, restricted extraocular movements, pain on extraocular movements, decreased visual acuity, conjunctival hyperemia and chemosis, however, are worrisome for orbital cellulitis. When orbital cellulitis is suspected, diagnostic CT should be obtained. Mild periorbital cellulitis may be treated with oral antibiotics and close follow-up, but orbital cellulitis requires ophthalmology consultation and admission for IV antibiotics.

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