High risk and low prevalence diseases: Orbital cellulitis

Area of Science:

• Ophthalmology
• Emergency Medicine
• Infectious Diseases

Background:

• Orbital cellulitis is an uncommon but serious infection of the tissues posterior to the orbital septum.
• It often arises from sinusitis, trauma, or dental infections, predominantly affecting pediatric patients.
• Prompt recognition and management are vital to prevent severe morbidity and vision loss.

Purpose of the Study:

• To review the presentation, diagnosis, and management of orbital cellulitis in the emergency department.
• To highlight critical considerations for emergency clinicians in managing this sight-threatening condition.
• To provide evidence-based guidance on diagnostic imaging and treatment strategies.

Main Methods:

• Review of current evidence on orbital cellulitis.
• Emphasis on clinical presentation and diagnostic workup in the emergency setting.
• Discussion of management principles, including antibiotics, imaging, and consultations.

Main Results:

• Orbital cellulitis requires immediate assessment for complications like orbital compartment syndrome.
• Computed tomography (CT) and magnetic resonance imaging (MRI) are essential for diagnosing complications.
• Point-of-care ultrasound (POCUS) can aid in differentiating preseptal from orbital cellulitis but cannot rule out intracranial extension.

Conclusions:

• Effective management of orbital cellulitis involves early broad-spectrum antibiotics and ophthalmology consultation.
• Steroid use remains controversial.
• Neurosurgery consultation is indicated for intracranial extension of infection.