Periorbital and orbital infections.

Abstract

1. Ellen R. Wald, MD* 1. *Professor of Pediatrics and Otolaryngology, University of Pittsburgh School of Medicine; Chief, Division of Allergy, Immunology, and Infectious Diseases, Children’s Hospital of Pittsburgh, Pittsburgh, PA After completing this article, readers should be able to: 1. Describe the specific causes of preseptal cellulitis. 2. Discuss the management of preseptal cellulitis. 3. Know the specific manifestations of postseptal cellulitis. 4. Recognize the orbital septum as a connective tissue extension of the periosteum (or periorbita) that is reflected into the upper and lower eyelids. 5. Identify the usual signals of orbital involvement. Practitioners frequently have the opportunity to manage the child whose chief complaint is a “swollen eye.” Some children have trivial or self-limited disorders, but others can have sight- or life-threatening problems. The noninfectious causes of swelling of or around the eye include: 1) blunt trauma (leading to the proverbial “black” eye), 2) tumor, 3) local edema, and 4) allergy. In cases of blunt trauma, the history provides the key to the diagnosis. Eyelid swelling continues to increase for 48 hours and then resolves over several days. Tumors that characteristically involve the eye include hemangiomas of the lid, ocular tumors such as retinoblastoma and choroidal melanoma, and orbital neoplasms such as neuroblastoma and rhabdomyosarcoma. (1) Tumors usually cause a gradual onset of proptosis in the absence of inflammation. Hypoproteinemia and congestive heart failure cause eyelid swelling due to local edema. Characteristic findings are bilateral, boggy, nontender, nondiscolored soft-tissue swelling. Allergic inflammation includes angioneurotic edema or contact hypersensitivity. (2) Superficially, these problems can resemble acute infection. However, the presence of pruritus and the absence of tenderness are helpful distinguishing characteristics. The anatomy of the eye is important for understanding its susceptibility to spread of infection from contiguous structures. Veins that drain the orbit, the ethmoid and maxillary sinuses, and the skin of the eye and periorbital tissues (Fig. 1) represent an anastomosing and valveless network. (1) This venous system provides opportunities for spread of infection from one anatomic site to another and predisposes …