Orbital Cellulitis: Clinical Management
Ocular Emergency: NEET PG High-Yield
1. Overview
Orbital cellulitis is a life- and vision-threatening infection of the soft tissues posterior to the orbital septum. It is fundamentally an orbital emergency requiring rapid diagnosis and systemic management.
2. Clinical Hallmark Features
- Proptosis: Forward displacement of the globe.
- Ophthalmoplegia: Painful and restricted eye movements.
- Vision Loss: Decreased visual acuity or sluggish pupillary response (suggestive of optic nerve involvement).
- Systemic Signs: High fever, leukocytosis, and significant malaise.
3. Diagnostic Approach
| Tool | Clinical Role |
|---|---|
| CT Scan (Contrast) | Gold standard: Evaluates orbital involvement, sinus disease, and abscess formation. |
| Blood Cultures | Indicated for systemic sepsis (especially in pediatric patients). |
4. NEET PG High-Yield Pearls
- Primary Cause: Direct extension from acute ethmoid sinusitis is the most common etiology in children.
- Chandler Classification: Know this staging system (Stage I: Preseptal; Stage II: Orbital cellulitis; Stage III: Subperiosteal abscess; Stage IV: Orbital abscess; Stage V: Cavernous sinus thrombosis).
- Management: Immediate hospital admission for intravenous broad-spectrum antibiotics. Surgical drainage is mandatory if there is a drainable abscess or if there is no response to medical therapy within 24–48 hours.
- Differential: Must rule out orbital pseudotumor (thyroid eye disease usually presents with bilateral proptosis and is typically painless/less systemic distress).