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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. 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

103. 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

104. 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

105. 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

106. Haemophilus Influenzae Infection (Diagnosis)

, 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

107. 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

108. 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

109. 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

110. 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

111. 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

112. 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

113. 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

114. 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

115. 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

116. Chronic keratoconjunctivitis with dermatitis as a presenting sign of child abuse. (Abstract)

Chronic keratoconjunctivitis with dermatitis as a presenting sign of child abuse. A 13-month-old girl presented with chronic keratoconjunctivitis with dermatitis. She was initially diagnosed with corneal abrasion and mild preseptal cellulitis and was treated with topical and oral antibiotics. After failing to respond to standard therapy, she was eventually identified as a victim of abuse. We discuss key findings that could have provoked earlier recognition.Copyright © 2012 American Association

2012 JAAPOS - Journal of the American Association for Pediatric Ophthalmology and Strabismus

117. Sinusitis

between/behind the eyes, the sides of the upper part of the nose (the ), and headaches (J01.2/J32.2) – can cause pain or pressure behind the eyes, but is often in the , over the , or the back of the head. Complications [ ] Stage Description I Preseptal cellulitis II Orbital cellulitis III Subperiosteal abscess IV Orbital abscess V Cavernous sinus septic thrombosis The proximity of the brain to the sinuses makes the most dangerous complication of sinusitis, particularly involving the frontal (...) spread to the orbit may result in periorbital , subperiosteal , orbital cellulitis, and abscess. Orbital cellulitis can complicate acute if anterior and posterior enables the spread of the infection to the lateral or orbital side of the . Sinusitis may extend to the , where it may cause cavernous sinus , retrograde , and epidural, subdural, and brain abscesses. Orbital symptoms frequently precede intracranial spread of the infection . Other complications include sinobronchitis, maxillary

2012 Wikipedia

118. Pediatric subperiosteal orbital abscess secondary to acute sinusitis: a 5-year review. (Abstract)

the patients who were admitted to the Pediatric Surgical Ward in Sarawak General Hospital, Kuching, Malaysia, between January 2004 and May 2009 were retrospectively reviewed. Records of patients who presented with preseptal cellulitis, orbital cellulitis, subperiosteal abscess (extraconal), orbital abscess (intraconal), and cavernous sinus thrombosis were closely studied. Ophthalmology consultations were obtained in all these cases. Ultimately, 3 patients having SPOA secondary to acute sinusitis were (...) with preexisting risk factors and immature immunity are at risk of severe and rare infections. Contrast-enhanced paranasal sinus computed tomographic scan is mandatory and reliable to differentiate preseptal and postseptal orbital infection, as both conditions can present similarly and rapidly deteriorate. In the contrast-enhanced computed tomography-demonstrable SPOA, endoscopic sinus surgery drainage of the abscess proved to be safe and reliable as the main treatment modality. All patients recovered well

2009 American Journal of Otolaryngology

119. Acute bacterial rhinosinusitis and its complications in our pediatric otolaryngological department between 1997 and 2006. (Abstract)

age range was between 3 and 6 years. The highest number of admissions occurred in March. The maxillary sinus was most frequently involved. Orbital complications were observed in 150 patients: 126 cases of preseptal cellulitis, 9 of orbital cellulitis, 4 of subperiosteal abscess, and 11 of orbital abscess. Further two children were diagnosed with intracranial complications, four patients presented with osteomyelitis and the remaining one exhibited mucocele. Streptococcus pneumoniae was the most

2009 International Journal of Pediatric Otorhinolaryngology

120. Ocular Emergencies

in nonselected subjects: the Rotterdam Study. Invest Ophthalmolol V is Sci 1997;38:2683–7. ocular movements. The eye and surrounding tissue will be chemotic and visual acuity may be poor 2 (Figure 5). History may indicate a specific cause, including extension of an existing infection of the paranasal sinuses or adjacent structures and from inoculation as a result of recent facial trauma or surgery. It is important to differentiate orbital cellulitis from the more common preseptal cellulitis. Preseptal (...) cellulitis rarely exhibits localised swelling which may mimic proptosis, however the eye is not proptosed and ocular movements are normal. Preseptal cellulitis rarely affects v i s i o n o r p r e s e n t s w i t h r e d e y e . U n t r e a t e d o r b i t a l c e l l u l i t i s c a n l e a d t o meningitis, brain abscess and cavernous sinus thrombosis, therefore immediate specialised care and hospitalisation is required. 1 Signs of deterioration may include binocular involvement and an increase

2008 The Royal Australian College of General Practitioners

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