Analgesics such as NSAIDs and acetaminophen can be used alone or in combination to achieve effective pain control in patients with orbital cellulitis. Further details on specific antibiotics will be explained in the diagnosis section. Antifungals are indicated only when a fungal infection is suspected in the appropriate clinical setting. The antibiotic regimen should also include coverage for anaerobes when an intracranial extension is suspected. aureus ), Streptococcus pneumoniae, other Streptococci, as well as gram-negative bacilli. aureus (including methicillin-resistant S. The choice of antibiotics is broad spectrum regimens aimed at covering for organisms such as S. Those complications include loss of vision, subperiosteal abscess, orbital abscess, and intracranial extension of the infection. Without prompt diagnosis and proper treatment, the infection of the orbit can progress and extend to the adjacent anatomical locations and result in serious complications. An ophthalmologist and otolaryngologist should also be consulted for proper examination and because, in some cases, surgery may be required. Treatment of orbital cellulitis includes antibiotics and other supportive therapies. Due to the controversy surrounding imaging use and the risks of radiation exposure to the pediatric population, there are guidelines and recommendation in place that highlight the indications and aid in the proper use of imaging for diagnosis of orbital cellulitis. The diagnosis of orbital cellulitis can be confirmed by imaging modalities such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). Orbital cellulitis also typically cause eyelid swelling with or without erythema however, these findings are also seen in another less serious condition called preseptal cellulitis. The most important distinguishing feature of orbital cellulitis is the presence of ophthalmoplegia, the presence of pain with eye movement, and/or proptosis. Orbital cellulitis is primarily diagnosed clinically by objective findings on physical examination combined with presenting signs and symptoms. Other rare reported cause of orbital cellulitis is mycobacteria, especially Mycobacterium tuberculosis. Aspergillus infection of the orbit occurs in patients with severe neutropenia or other immune deficiencies, such as HIV infection. Mucormycosis affects patients with diabetic ketoacidosis as well as the patients with renal acidosis. In immunocompromised patients with orbital cellulitis, mucormycosis and invasive aspergillosis should be considered as the cause of orbital cellulitis. Fungal pathogens causing invasive orbital cellulitis include Mucorales which causes mucormycosis and Aspergillus which can cause life-threatening invasive orbital infections. Rare cases of orbital cellulitis caused by non-spore-forming anaerobes Aeromonas hydrophila, Pseudomonas aeruginosa, and Eikenella corrodens have also been reported. The most common bacterial organisms causing orbital cellulitis are Staphylococcus aureus and Streptococci species. The causative organisms of orbital cellulitis are commonly bacterial but can also be polymicrobial, often including aerobic and anaerobic bacteria and even fungal or mycobacteria. Although orbital cellulitis can occur at any age, it is more common in the pediatric population. Orbital cellulitis does not involve the globe itself. It is also sometimes referred to as postseptal cellulitis. Orbital cellulitis is defined as a serious infection that involves the muscle and fat located within the orbit. This activity reviews the cause, pathophysiology and presentation of orbital cellulitis and highlights the role of the interprofessional team in its management. Although orbital cellulitis can occur at any age, it is more common in the pediatric population.The causative organisms of orbital cellulitis are commonly bacterial but can also be polymicrobial, often including aerobic and anaerobic bacteria and even fungal or mycobacteria.
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