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Preseptal Cellulitis

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81. Haemophilus Influenzae Infections (Follow-up)

cellulitis, administer parenteral antibiotics until the patient shows defervescence and the cellulitis subsides. Then, administer appropriate oral antibiotics until the course of therapy, usually 7-10 days, is finished. Empiric therapy for preseptal cellulitis should cover not only Hib but also S pneumoniae, Staphylococcus aureus, and group A beta-hemolytic streptococci. Hib was once one of the most common pathogens in preseptal and orbital cellulitis in children before the Hib vaccine became widely (...) on circumstances. Pediatr Infect Dis J . 2013 Dec. 32 (12):1381-2. . Syrogiannopoulos GA, Lourida AN, Theodoridou MC, et al. Dexamethasone therapy for bacterial meningitis in children: 2- versus 4-day regimen. J Infect Dis . 1994 Apr. 169(4):853-8. . Lee S, Yen MT. Management of preseptal and orbital cellulitis. Saudi J Ophthalmol . 2011 Jan. 25 (1):21-9. . Orbital Cellulitis. American Academy of Ophthalmology. Available at . Accessed: September 27, 2017. Lawrence R. Guidelines for the management of ADULTS

2014 eMedicine.com

82. Nasolacrimal Duct, Obstruction (Follow-up)

for early infections. Systemic antibiotics may be necessary for more chronic or severe infections, such as those causing dacryocystitis, canaliculitis, or preseptal cellulitis (may progress to orbital abscesses). Although sensitive to penicillin, Actinomyces organisms usually require complete removal of the canalicular stones for complete treatment. Next: Surgical Care External dacryocystorhinostomy See the list below: Criterion standard of lacrimal bypass surgeries Success rates up to 95% Facilitates

2014 eMedicine.com

83. Pediatric Sinusitis, Medical Treatment

these children is to combine antibiotic therapy with treatment of associated conditions for a time sufficient to allow resolution of symptoms with return of normal sinus physiology and mucociliary clearance. This article addresses the medical management of pediatric sinusitis. See the image below. Preseptal cellulitis of the left eye. Courtesy of Dwight Jones, MD. Diagnosis and management Laboratory tests are normally not particularly helpful in making the diagnosis of sinusitis. However, they can (...) . . Venekamp RP, Thompson MJ, Hayward G, et al. Systemic corticosteroids for acute sinusitis. Cochrane Database Syst Rev . 2014 Mar 25. 3:CD008115. . Brook I. The role of antibiotics in pediatric chronic rhinosinusitis. Laryngoscope Investig Otolaryngol . 2017 Jun. 2 (3):104-8. . . Media Gallery Preseptal cellulitis of the left eye. Courtesy of Dwight Jones, MD. Axial CT scan of subperiosteal abscess of the left eye. Coronal CT scan of subperiosteal abscess of the left eye. Coronal CT scan of superior

2014 eMedicine Surgery

84. Orbit, Infection

and cellulitis, and a trend was seen toward lower ADC in orbital inflammatory syndrome than in cellulitis. [ ] Preferred examination CT scanning is often the first imaging modality that is used because of its ease and availability at most medical institutions. [ , , ] On CT scans, a preseptal cellulitis may appear as an area of increased density, with swelling of the anterior orbital tissues and obliteration of the adjacent fat planes. When the infection progresses, an increase in the density of the orbital (...) multiple myeloma. In addition, the patient had infectious dacryoadenitis with Staphylococcus aureus infection and an abscess collection. Coronal computed tomography scan of a patient with dacryoadenitis and Staphylococcus aureus infection, resulting in an abscess. A diagnosis of dacryocystitis is made clinically unless adjacent periorbital cellulitis is present, limiting the ophthalmologic evaluation. Because the lacrimal sac is a preseptal structure, radiographic imaging in patients with periorbital

2014 eMedicine Radiology

85. Sinusitis, Chronic (Follow-up)

to an otolaryngologist when they manifest any of these signs and/or symptoms: double or reduced vision, proptosis, rapidly developing periorbital edema, ophthalmoplegia, focal neurologic signs, high fever, severe headache, meningeal irritation, or significant or recurrent nose bleeding. [ ] Orbital complications include preseptal cellulitis, subperiosteal abscess, orbital cellulitis, orbital abscess, and cavernous sinus thrombosis. Intracranial complications include meningitis, epidural abscess, subdural abscess (...) is new and where next?. J Laryngol Otol . 2015 Aug. 129 (8):744-51. . Nayak N, Satpathy G, Prasad S, Thakar A, Chandra M, Nag TC. Clinical implications of microbial biofilms in chronic rhinosinusitis and orbital cellulitis. BMC Ophthalmol . 2016 Sep 21. 16 (1):165. . Brook I, Foote PA, Hausfeld JN. Increase in the frequency of recovery of meticillin-resistant Staphylococcus aureus in acute and chronic maxillary sinusitis. J Med Microbiol . 2008 Aug. 57:1015-7. . Brook I. Acute and chronic bacterial

2014 eMedicine.com

86. Sinusitis, Acute (Follow-up)

ophthalmological evaluation and appropriate radiological studies. CT scanning is the most sensitive means of diagnosing an orbital abscess, although ultrasound has been found to be 90% effective for diagnosing anterior abscesses. [ ] The classification by Chandler, which is based on physical examination findings, provides a reasonable framework to guide management. This classification consists of 5 groups of orbital inflammation [ ] : Group 1 - Inflammatory edema (preseptal cellulitis) with normal visual (...) acuity and extraocular movement Group 2 - Orbital cellulitis with diffuse orbital edema but no discrete abscess Group 3 - Subperiosteal abscess beneath the periosteum of the lamina papyracea resulting in downward and lateral globe displacement Group 4 - Orbital abscess with chemosis, ophthalmoplegia, and decreased visual acuity Group 5 - Cavernous sinus thrombosis with rapidly progressive bilateral chemosis, ophthalmoplegia, retinal engorgement, and loss of visual acuity; possible meningeal signs

2014 eMedicine.com

87. Periorbital Infections (Treatment)

with periorbital cellulitis in children. Ann Otol Rhinol Laryngol . 2007 May. 116(5):386-8. . Charalampidou S, Connell P, Fennell J, et al. Preseptal cellulitis caused by community acquired methicillin resistant Staphylococcus aureus (CAMRSA). Br J Ophthalmol . 2007 Dec. 91(12):1723-4. . Ambati BK, Ambati J, Azar N, et al. Periorbital and orbital cellulitis before and after the advent of Haemophilus influenzae type B vaccination. Ophthalmology . 2000 Aug. 107(8):1450-3. . Donahue SP, Schwartz G. Preseptal (...) and orbital cellulitis in childhood. A changing microbiologic spectrum. Ophthalmology . 1998 Oct. 105(10):1902-5; discussion 1905-6. . Schwartz GR, Wright SW. Changing bacteriology of periorbital cellulitis. Ann Emerg Med . 1996 Dec. 28(6):617-20. . Green JA, Lim J, Barkham T. Neisseria gonorrhoeae: a rare cause of preseptal cellulitis?. Int J STD AIDS . 2006 Feb. 17(2):137-8. . Chand DV, Hoyen CK, Leonard EG, et al. First reported case of Neisseria meningitidis periorbital cellulitis associated

2014 eMedicine Emergency Medicine

88. Sinusitis (Treatment)

ophthalmological evaluation and appropriate radiological studies. CT scanning is the most sensitive means of diagnosing an orbital abscess, although ultrasound has been found to be 90% effective for diagnosing anterior abscesses. [ ] The classification by Chandler, which is based on physical examination findings, provides a reasonable framework to guide management. This classification consists of 5 groups of orbital inflammation [ ] : Group 1 - Inflammatory edema (preseptal cellulitis) with normal visual (...) acuity and extraocular movement Group 2 - Orbital cellulitis with diffuse orbital edema but no discrete abscess Group 3 - Subperiosteal abscess beneath the periosteum of the lamina papyracea resulting in downward and lateral globe displacement Group 4 - Orbital abscess with chemosis, ophthalmoplegia, and decreased visual acuity Group 5 - Cavernous sinus thrombosis with rapidly progressive bilateral chemosis, ophthalmoplegia, retinal engorgement, and loss of visual acuity; possible meningeal signs

2014 eMedicine Emergency Medicine

89. Orbital Infections (Treatment)

Infections Treatment & Management Updated: Nov 19, 2018 Author: Keith A Lafferty, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD Share Email Print Feedback Close Sections Sections Orbital Infections Treatment Emergency Department Care Patients with preseptal cellulitis may be discharged home with oral antibiotics and close follow up only after ruling out postseptal disease either clinically or radiographically. Admit patients with orbital signs and quickly initiate IV antibiotics or antifungals (...) cellulitis in children?. J Fam Pract . 2007 Aug. 56(8):662-4. . Aygün D, Doğan C, Hepokur M, Arslan OŞ, Çokuğraş H, Camcıoglu Y. Evaluation of patients with orbital infections. Turk Pediatri Ars . 2017 Dec. 52 (4):221-225. . Donahue SP, Schwartz G. Preseptal and orbital cellulitis in childhood. A changing microbiologic spectrum. Ophthalmology . 1998 Oct. 105(10):1902-5; discussion 1905-6. . Farnath D. Ocular infections. Infectious Disease in Emergency Medicine . 2nd ed. 1998. 843-58. Ghezzi K, Renner GS

2014 eMedicine Emergency Medicine

90. Hordeolum and Stye (Treatment)

: a randomized, placebo-controlled trial: a pilot study. J Med Assoc Thai . 2005 May. 88(5):647-50. . Barza M, Baum J. Ocular infections. Med Clin North Am . 1983 Jan. 67(1):131-52. . Benton J, Karkanevatos A. Preseptal cellulitis due to Mycobacterium marinum. J Laryngol Otol . 2007 Jun. 121(6):606-8. . Brafman AH. Styes: a curious chain. Br J Gen Pract . 1992 Dec. 42(365):537-8. . Briner AM. Surgical treatment of a chalazion or hordeolum internum. Aust Fam Physician . 1987 Jun. 16(6):834-5. . Briner AM

2014 eMedicine Emergency Medicine

91. Hordeolum and Stye (Follow-up)

: a randomized, placebo-controlled trial: a pilot study. J Med Assoc Thai . 2005 May. 88(5):647-50. . Barza M, Baum J. Ocular infections. Med Clin North Am . 1983 Jan. 67(1):131-52. . Benton J, Karkanevatos A. Preseptal cellulitis due to Mycobacterium marinum. J Laryngol Otol . 2007 Jun. 121(6):606-8. . Brafman AH. Styes: a curious chain. Br J Gen Pract . 1992 Dec. 42(365):537-8. . Briner AM. Surgical treatment of a chalazion or hordeolum internum. Aust Fam Physician . 1987 Jun. 16(6):834-5. . Briner AM

2014 eMedicine Emergency Medicine

92. Orbital Infections (Diagnosis)

spread of sinusitis, with the ethmoid sinus being the most commonly implicated owing to its thin and porous walls (lamina papyracea). Infections also can spread from the preseptal space, particularly from preseptal (or periorbital) cellulitis in children, as well as from the pharynx, middle ear, facial skin, nose, lacrimal gland (dacryocystitis), or dentition. The ease and rapidity of such infectious spread relates to the facial venous system, which has a great number of anastomoses and is entirely (...) valveless. Infectious material can be inoculated directly into the orbital soft tissue secondary to trauma, surgery, or orbital foreign bodies. More rarely, orbital infections develop from hematogenous seeding secondary to sepsis or bacterial endocarditis. Orbital infections are classified by a 5-tier system, as described by Smith and Spencer and modified by Chandler et al. Group I - Preseptal cellulitis Group II - Orbital cellulitis Group III - Subperiosteal abscess Group IV - Orbital abscess Group V

2014 eMedicine Emergency Medicine

93. Periorbital Infections (Diagnosis)

of the superficial skin around the eyes are called periorbital, or preseptal, . These infections are limited to the area anterior to the orbital septum. is predominantly, although not exclusively, a pediatric disease (see the image below). (See Presentation, Workup, Treatment, and Medication.) [ , ] Periorbital cellulitis. This image shows an 8-year-old patient who presented with unilateral eyelid swelling and erythema. Periorbital cellulitis represents the first of the 5 nonprogressive types of orbital (...) infections. These are classified as follows [ ] : Group 1 - Preseptal cellulitis Group 2 - Orbital cellulitis Group 3 - Subperiosteal abscess Group 4 - Orbital abscess Group 5 - Cavernous sinus thrombosis Lacrimal system infections Infections of the lacrimal system are classified based on the location of the infection; they include the following (see Presentation, Workup, Treatment, and Medication): - Inflammation of the lid margins; anterior blepharitis affects the area of the lid where the eyelashes

2014 eMedicine Emergency Medicine

94. Dacryocystitis (Diagnosis)

caused by a systemic disease. The primary morbidity is associated with chronic tearing, mattering, and conjunctival inflammation and infection. Congenital dacryocystitis is a very serious disease associated with significant morbidity and mortality. If not treated promptly and aggressively, newborn infants can experience orbital cellulitis (because the orbital septum is formed poorly in infants), brain abscess, meningitis, sepsis, and death. Congenital dacryocystitis can be associated (...) and preseptal orbicularis muscles. Anteriorly, the medial canthal tendon covers the upper two fifths of the lacrimal sac. The nasolacrimal duct averages 18 mm in length and 4.5-5 mm in diameter. Multiple valves are present in the nasolacrimal duct, representing analog from the segmental canalization of the ectodermal cord that develops into the nasolacrimal duct. Of these, the most prominent valves are the valve of Taillefer, the valve of Krause, and the valve of Hasner (located at the junction of the duct

2014 eMedicine.com

95. Cutaneous Tuberculosis (Diagnosis)

. Adnexal or orbital disease may be seen with preauricular lymphadenopathy. Because of the wide variability in the disease process, presenting complaints will vary. Most often, patients will complain of blurry vision that may or may not be associated with pain and red eye. In the rare case of orbital disease, proptosis, double vision, or extraocular muscle motility restriction may be the presenting complaint. Preseptal cellulitis in children with spontaneous draining fistula may also occur. In cases

2014 eMedicine.com

96. Haemophilus Influenzae Infections (Diagnosis)

are as follows: Hib meningitis: Most serious manifestation of Hib infection; antecedent upper respiratory tract infections are common; Hib meningitis manifestations indistinguishable from other bacterial meningitis causes Cellulitis: Most commonly involves the buccal and periorbital regions; usually associated with fever Epiglottitis: Fever, sore throat, dysphagia, drooling, and difficulty breathing Hib pneumonia: Clinically indistinguishable from other bacterial pneumonias—but usually with insidious onset (...) is guaranteed): To confirm epiglottitis and/or assess cervical spine Echocardiography: For suspected pericarditis Procedures Endotracheal intubation or tracheostomy: To secure airway in patients with epiglottitis Lumbar puncture: When meningitis is suspected Bronchoscopy Aspiration of soft or subcutaneous tissue in the presence of cellulitis Joint, lung, and sinus aspiration Transtracheal aspiration Tympanocentesis Pericardiocentesis Laparoscopy and tubal cultures in women: For suspected NTHi Culdocentesis

2014 eMedicine.com

97. Haemophilus Influenzae Infection (Overview)

, Neisseria meningitidis, and Streptococcus pneumoniae in children in England over five decades: a population-based observational study. Lancet Infect Dis . 2014 May. 14(5):397-405. . Friesen CA, Cho CT. Characteristic features of neonatal sepsis due to Haemophilus influenzae. Rev Infect Dis . 1977. 8:777. . Lessner A, Stern GA. Preseptal and orbital cellulitis. Infect Dis Clin North Am . 1992 Dec. 6(4):933-52. . Kroger AT, Sumaya CV, Pickering LK, Atkinson WL. General recommendations on immunization (...) . The unencapsulated strains were chiefly responsible for infections at mucosal surfaces, including , conjunctivitis, , and . In contrast, one of the 6 antigenically distinct encapsulated strains, strain type b, was associated with invasive diseases (eg, septicemia, meningitis, cellulitis, septic , epiglottitis, ). Prior to the availability of an effective vaccine, H influenzae type b (Hib) was the most common cause of pediatric bacterial meningitis in the United States. Next: Pathophysiology Pathogenesis A major

2014 eMedicine Pediatrics

98. Haemophilus Influenzae Infection (Follow-up)

. Characteristic features of neonatal sepsis due to Haemophilus influenzae. Rev Infect Dis . 1977. 8:777. . Lessner A, Stern GA. Preseptal and orbital cellulitis. Infect Dis Clin North Am . 1992 Dec. 6(4):933-52. . Kroger AT, Sumaya CV, Pickering LK, Atkinson WL. General recommendations on immunization --- recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep . 2011 Jan 28. 60(2):1-64. . . Ward J, Lieberman JM, Cochi S. Haemophilus influenzae vaccines. Plotkin S, Mortimer

2014 eMedicine Pediatrics

99. Sinusitis (Treatment)

ophthalmological evaluation and appropriate radiological studies. CT scanning is the most sensitive means of diagnosing an orbital abscess, although ultrasound has been found to be 90% effective for diagnosing anterior abscesses. [ ] The classification by Chandler, which is based on physical examination findings, provides a reasonable framework to guide management. This classification consists of 5 groups of orbital inflammation [ ] : Group 1 - Inflammatory edema (preseptal cellulitis) with normal visual (...) acuity and extraocular movement Group 2 - Orbital cellulitis with diffuse orbital edema but no discrete abscess Group 3 - Subperiosteal abscess beneath the periosteum of the lamina papyracea resulting in downward and lateral globe displacement Group 4 - Orbital abscess with chemosis, ophthalmoplegia, and decreased visual acuity Group 5 - Cavernous sinus thrombosis with rapidly progressive bilateral chemosis, ophthalmoplegia, retinal engorgement, and loss of visual acuity; possible meningeal signs

2014 eMedicine Pediatrics

100. Orbital Infections (Follow-up)

. Clinical inquiries. What is the best initial treatment for orbital cellulitis in children?. J Fam Pract . 2007 Aug. 56(8):662-4. . Aygün D, Doğan C, Hepokur M, Arslan OŞ, Çokuğraş H, Camcıoglu Y. Evaluation of patients with orbital infections. Turk Pediatri Ars . 2017 Dec. 52 (4):221-225. . Donahue SP, Schwartz G. Preseptal and orbital cellulitis in childhood. A changing microbiologic spectrum. Ophthalmology . 1998 Oct. 105(10):1902-5; discussion 1905-6. . Farnath D. Ocular infections. Infectious (...) , glaucoma, optic neuritis, central retinal artery occlusion, or optic nerve infection (10-33%) Cavernous sinus thrombosis – Usually die of meningitis or other CNS infection (30% mortality) Intracranial involvement (20-40% mortality) Previous References Mathew A, Craig E, Al-Mahmoud R, Batty R, Raghavan A, Mordekar S, et al. Paediatric Post-septal and Pre-septal Cellulitis: 10-year Experience at a Tertiary-level Children's Hospital. Br J Radiol . 2013 Nov 28. . Nemet AY, Ferencz JR, Segal O, Meshi

2014 eMedicine Emergency Medicine

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