Enfermeria

Orbital and Periorbital Cellulitis Keith R. Powell Pediatrics in Review 1995;16;163 DOI: 10.1542/pir.16-5-163

The online version of this article, along with updated information and services, is located on the World Wide Web at: http://pedsinreview.aappublications.org/content/16/5/163

Pediatrics in Review is the official journal of the American Academy of Pediatrics. A monthly publication,it has been published continuously since 1979. Pediatrics in Review is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 1995 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0191-9601.

Downloaded from http://pedsinreview.aappublications.org/ at Health Internetwork on May15, 2012

ARTICLE

Orbital
Keith A. Powell,
FOCUS
1.

and
MD*
QUESTIONS

Periorbital
Epidemiology Pathogenesis Periorbital

Cellulitis
and of Cellulitis
by either type b (Hib) or S pneumoniae had a history of trauma to the affected eye; yet, there was no evidence of a local wound infection in any of these children. If there is evidence of a nidus of infection at the site of awound or an insect bite, the clinician should consider S aureus or S pyogenes as the cause of periorbital cellulitis. If there is a history of trauma but no evidence of an infected portal of entry, then the history is much less helpful in determining the causative pathogen. Periorbital swelling and redness also can result from inflammatory edema secondary to ethmoid, frontal, or maxillary sinusitis.The swelling usually is painless and is thought to result from the hindrance of venous drainage from periorbital structures into veins that pass through the sinuses because the veins are partially obstructed by inflamed tissues in the sinuses. If sinusitis is treated appropriately, the periorbital swelling resolves without any knowledge of whether it was infected. (The diagnosis and treatment ofsinusitis was last reviewed in Pediatrics in Review. 1993;9:345-35 1). Preseptal infection also occurs when the periorbital tissues are
Haemophilus influenzae

have

bacteremia

caused

What conditions may present as acute eyelid redness and swelling in an infant or child? 2. What are the clinical features of periorbital (preseptal) cellulitis? 3. When should orbital cellulitis besuspected in a child who has red and swollen eyelids? 4. What laboratory evaluations are appropriate for a child who has periorbital or orbital cellulitis? 5. What antibiotics are appropriate for the management of periorbital or orbital cellulitis?

The acute onset of eyelid redness and swelling in a child usually results in a quick visit to the doctor’s office or an emergency room. The differentialdiagnosis for these signs ranges from relatively innocuous problems, such as allergy or an insect sting, to potentially vision-affecting or even lifethreatening diseases, such as orbital cellulitis or cavernous vein thrombosis. The orbital contents often are protected from an inflammatory process by the orbital septum, a continuation of the periosteum of the bony orbit to the margins of both theupper and lower eyelids (Figure 1). An inflammatory process occurring in the structures superficial to the orbital septum is defined as preseptal or periorbital cellulitis; an inflammatory process in structures deep to the orbital septum is defined as orbital cellulitis or a specific complication thereof. Bacterial infection can cause both periorbital and orbital cellulitis. Another anatomic featureof imevidence of portance is that the skin of the eyelid trauma and are is the thinnest skin of the body. The infected with subcutaneous tissue of the eyelid is pathogens that composed of musculofibrous tissue reach the periorand no fat. This combination of thin bital tissues from skin and loose subcutaneous tissues the paranasal makes it possible for the eyelid to sinuses or via the swell...