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Preseptal Cellulitis

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81. Sinusitis, Acute (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.com

82. Sinusitis, Chronic (Treatment)

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

83. Haemophilus Influenzae Infections (Treatment)

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

84. Hordeolum (Treatment)

blepharoconjunctivitis. [ , ] Nonsurgical remedies for hordeolum, although unproven, [ ] do not seem to be harmful. If an external hordeolum is centered around a lash follicle, the lash can be pulled to enhance drainage. Systemic antibiotics may be indicated if the hordeola is complicated by preseptal cellulitis. Oral doxycycline may also be added if there is a history of multiple or recurrent lesions or if there is significant and chronic meibomitis. Internal hordeola may occasionally evolve into chalazia, which

2014 eMedicine.com

85. Thyroid Ophthalmopathy (Treatment)

, strabismus, and appearance), especially in North America, and the European Group of Graves’ Orbitopathy (EUGOGO) Classification in Europe. Both grading criteria have roots in the NOSPECS and clinical activity score classifications. [ ] Previous Next: Diagnostic Considerations Orbital and preseptal cellulitis are included in the differential diagnosis when evaluating a patient with suspected thyroid-associated ophthalmopathy (thyroid ophthalmopathy). In orbital cellulitis, the onset of proptosis is often

2014 eMedicine.com

86. Thyroid Ophthalmopathy (Overview)

, strabismus, and appearance), especially in North America, and the European Group of Graves’ Orbitopathy (EUGOGO) Classification in Europe. Both grading criteria have roots in the NOSPECS and clinical activity score classifications. [ ] Previous Next: Diagnostic Considerations Orbital and preseptal cellulitis are included in the differential diagnosis when evaluating a patient with suspected thyroid-associated ophthalmopathy (thyroid ophthalmopathy). In orbital cellulitis, the onset of proptosis is often

2014 eMedicine.com

87. Haemophilus Influenzae Infections (Overview)

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

88. Dacryocystitis (Overview)

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

89. Cutaneous Tuberculosis (Overview)

. 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

90. Nasolacrimal Duct, Obstruction (Treatment)

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

91. 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

92. Thyroid Ophthalmopathy (Follow-up)

, strabismus, and appearance), especially in North America, and the European Group of Graves’ Orbitopathy (EUGOGO) Classification in Europe. Both grading criteria have roots in the NOSPECS and clinical activity score classifications. [ ] Previous Next: Diagnostic Considerations Orbital and preseptal cellulitis are included in the differential diagnosis when evaluating a patient with suspected thyroid-associated ophthalmopathy (thyroid ophthalmopathy). In orbital cellulitis, the onset of proptosis is often

2014 eMedicine.com

93. 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

94. 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

95. Haemophilus Influenzae Infection (Treatment)

admission rates for meningitis and septicaemia caused by Haemophilus influenzae, 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 (...) that may be necessary include the following: Tracheotomy - For Hib epiglottitis when the airway cannot be managed with endotracheal intubation Arthrocentesis or bone debridement - For osteomyelitis or septic arthritis, particularly involving the hip Neurosurgery - For subdural empyema complicating meningitis or intracranial complications of orbital cellulitis [ ] Surgical drainage - For septic arthritis of the hip joint Open drainage - For most cases of septic arthritis of the shoulder Early

2014 eMedicine Pediatrics

96. 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

97. 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

98. Cavernous Sinus Thrombosis (Follow-up)

sinuses. Arch Neurol . 1988 May. 45(5):567-72. . Ferro JM, Canhao P, Bousser MG. Cerebral vein and dural sinus thrombosis in elderly patients. Stroke . 2005 Sep. 36(9):1927-32. . Goodwin WJ. Orbital complications of ethmoiditis. Otolaryngol Clin North Am . 1985 Feb. 18(1):139-47. . Heckmann JG, Tomandl B. Cavernous sinus thrombosis. Lancet . 2003 Dec 13. 362(9400):1958. . Karlin RJ, Robinson WA. Septic cavernous sinus thrombosis. Ann Emerg Med . 1984 Jun. 13(6):449-55. . Lessner A, Stern GA. Preseptal (...) and orbital cellulitis. Infect Dis Clin North Am . 1992 Dec. 6(4):933-52. . Levine SR, Twyman RE, Gilman S. The role of anticoagulation in cavernous sinus thrombosis. Neurology . 1988 Apr. 38(4):517-22. . Peters KS. Secondary headache and head pain emergencies. Prim Care . 2004 Jun. 31(2):381-93, vii. . Schnipper D, Spiegel JH. Management of intracranial complications of sinus surgery. Otolaryngol Clin North Am . 2004 Apr. 37(2):453-72, ix. . Southwick FS, Richardson EP, Swartz MN. Septic thrombosis

2014 eMedicine Emergency Medicine

99. 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

100. 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

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