RT Book, Section
A1 Duncan, Jacque L.
A1 Parikh, Neeti B.
A1 Seitzman, Gerami D.
A2 Papadakis, Maxine A.
A2 McPhee, Stephen J.
A2 Rabow, Michael W.
A2 McQuaid, Kenneth R.
SR Print(0)
ID 1184192455
T1 Orbital Cellulitis
T2 Current Medical Diagnosis & Treatment 2022
YR 2022
FD 2022
PB McGraw-Hill Education
PP New York, NY
SN 9781264269389
LK accessmedicine.mhmedical.com/content.aspx?aid=1184192455
RD 2024/04/18
AB Orbital  cellulitis  is  characterized  by  fever,  proptosis,  restriction  of  extraocular  movements,  and  swelling  with  redness  of  the  lids  (eFigure  7–71).  Immediate  treatment  with  intravenous  antibiotics  is  necessary  to  prevent  optic  nerve  damage  and  spread  of  infection  to  the  cavernous  sinuses,  meninges,  and  brain.  Infection  of  the  paranasal  sinuses  is  the  usual  underlying  cause.  Infecting  organisms  include  S  pneumoniae,  the  incidence  of  which  has  been  reduced  by  the  administration  of  pneumococcal  vaccine;  other  streptococci,  such  as  the  anginosus  group;  H  influenzae;  and,  less  commonly,  S  aureus  including  MRSA.  Penicillinase-resistant  penicillin,  such  as  nafcillin,  is  recommended,  possibly  together  with  metronidazole  or  clindamycin  to  treat  anaerobic  infections.  If  trauma  is  the  underlying  cause,  a  cephalosporin,  such  as  cefazolin  or  ceftriaxone,  should  be  added  to  ensure  coverage  for  S  aureus  and  group  A  beta-hemolytic  streptococci.  If  MRSA  infection  is  a  concern,  vancomycin  or  clindamycin  may  be  required.  For  patients  with  penicillin  hypersensitivity,  vancomycin,  levofloxacin,  and  metronidazole  are  recommended.  The  response  to  antibiotics  is  usually  excellent,  but  surgery  may  be  required  to  drain  the  paranasal  sinuses  or  orbital  abscess.  In  immunocompromised  patients,  zygomycosis  must  be  considered.