Orbital and Pre-Orbital Cellulitis - Paediatrics

Orbital and Pre-Orbital Cellulitis

·        Want to determine if its:

o   Orbital cellulitis:

§  Eg spread from anterior ethmoid sinus 

§  Proptosis (eye pushed forward) and/or ophthalmoplegia (limitation of movement) and/or ¯ visual acuity 

§  Surgical emergency: discuss with ENT, ophthalmologists, radiologist re imaging (CT not MRI)

§  Bugs: S Aureus, also S pneumoniae, S pyogenes, HIB

§  Cefotaxime and flucloxacillin 

§  Complications: intracerebral extension (lumbar puncture contra-indicated until this is ruled out) 

o   Periorbital cellulitis: in superficial facia around the eye but not into the orbit. Fever and local tenderness

§  Investigations: FBC, blood cultures 

§  S pyogenes and S aureus especially if contiguous skin lesion, S pneumonia, HIB if not fully immunised (can check urine for antigens). If HIB then ?HIB meningitis and Rifampicin prophylaxis for patient and family 

§  Treatment:

·        If < 5 and not fully immunised: cefuroxime or Cefotaxime (50 mg/kg/6hr, max 2 g)

·        If > 5 or <5 and fully immunised: flucloxacillin (50 mg/kg/6 hr, max 2 g)

·        If no response after 24 – 48 hours, treat as for orbital cellulitis or underlying sinus disease

o   Local allergic reaction: eg just erythema without tenderness or temperature