How to Diagnose Orbital Cellulitis

Orbital cellulitis is an infection of the soft tissues of the eyelids. It has many causes and can have serious complications with up to 11 percent of cases resulting in a loss of vision. Orbital cellulitis requires prompt diagnosis because it can be highly infectious and is therefore an ophthalmological emergency.

Instructions

Difficulty: Challenging

1. Obtain a patient history. Patients with orbital cellulitis commonly have a history of recent dental work, facial surgery or infection elsewhere in the body.
2. Observe common presenting symptoms of orbital cellulitis. These include decreased vision, pain when moving the eyes and conjunctival chemosis. Non-specific symptoms such as fever and headaches also may be present.
3. Perform a physical examination of the eyes. The cardinal signs of orbital cellulitis include bulging eyes and a paralysis of the eye muscles. These symptoms also may be accompanied by elevated intraocular pressure, orbital tenderness and a dark red discoloration of the eyelids.
4. Conduct general laboratory tests. Take a blood culture before administering any antibiotics. The leukocyte count is commonly greater than 15,000, although this will probably not identify the causative organism. Make a culture of any nasal or sinus discharge in addition to discharge from any orbital abscesses.
5. Take a high-resolution Computed Tomography (CT) scan. Axial views are essential for eliminating brain abscesses and coronal views will be helpful in detecting subperiosteal abscesses. However, coronal views can be difficult to obtain in children and acutely ill patients. Magnetic Resonance Imaging (MRI) can identify orbital abscesses and sinus disease.