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Preseptal Cellulitis

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101. Periorbital Infections (Follow-up)

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

102. Sinusitis (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 Emergency Medicine

103. Hordeolum and Stye (Overview)

. Effectiveness of combined antibiotic ophthalmic solution in the treatment of hordeolum after incision and curettage: 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 (...) or Moll sebaceous glands. An internal hordeolum is a secondary infection of meibomian glands in the tarsal plate. Both types can arise as a secondary complication of blepharitis. Untreated, the disease may spontaneously resolve or it may progress to chronic granulation with formation of a painless mass known as a chalazion. Chalazia can be quite large and can cause visual disturbance by deforming the cornea. Generalized cellulitis of the eyelid may occur if an internal hordeolum is untreated. Most

2014 eMedicine Emergency Medicine

104. Cavernous Sinus Thrombosis (Overview)

. 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

2014 eMedicine Emergency Medicine

105. 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

106. 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 Emergency Medicine

107. Thyroid Ophthalmopathy (Diagnosis)

, 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

108. 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

109. 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

110. 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

111. Cavernous Sinus Thrombosis (Treatment)

. 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

2014 eMedicine Emergency Medicine

112. 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 Emergency Medicine

113. 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

114. Sinusitis (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 Pediatrics

115. Cavernous Sinus Thrombosis (Diagnosis)

. 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

2014 eMedicine Emergency Medicine

116. Hordeolum and Stye (Diagnosis)

, Wachirasereechai K. Effectiveness of combined antibiotic ophthalmic solution in the treatment of hordeolum after incision and curettage: 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 (...) and infection of Zeiss or Moll sebaceous glands. An internal hordeolum is a secondary infection of meibomian glands in the tarsal plate. Both types can arise as a secondary complication of blepharitis. Untreated, the disease may spontaneously resolve or it may progress to chronic granulation with formation of a painless mass known as a chalazion. Chalazia can be quite large and can cause visual disturbance by deforming the cornea. Generalized cellulitis of the eyelid may occur if an internal hordeolum

2014 eMedicine Emergency Medicine

117. 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

118. 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

119. Periorbital Infections (Overview)

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

120. Orbital Infections (Overview)

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

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