Orbital cellulitis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [2]

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Overview

Patients with orbital cellulitis usually appear ill. Physical examination of patients with orbital cellulitis is usually remarkable for fever, proptosis, ophthalmoplegia, and impaired visual acuity. Patients should undergo a complete physical examination, paying particular attention to general appearance, vital signs, visual acuity, visual field, orbital positioning, ocular movmements, oropharynx, and nasopharynx examinations.[1][2][3][4][5][6]

Physical Examination

Patients with orbital cellulitis usually appear ill. Physical examination of patients with orbital cellulitis is usually remarkable for fever, proptosis, ophthalmoplegia, and impaired visual acuity.The physical examination should assess:[1]

Signs

Patients with orbital cellulitis may present with some or all of the following signs:[1][2][3][4][5][6]

General Appearance

Patients with orbital cellulitis usually appear ill and have marked inflammation and edema of the periorbital area.

Vital Signs

Patients with orbital cellulitis may have the following vital signs, which are suggestive of infection:

Skin

Patients with orbital cellulitis may present with the following skin findings:

HEENT

Patients with orbital cellulitis may have the following HEENT findings on physical examination:

Head

Patients with orbital cellulitis may present with the following signs:

  • Evidence of recent orbital or head trauma, or surgery (e.g., scars, injuries, etc.)
  • Evidence of recent insect bites

Eyes

Patients with orbital cellulitis may present with some or all the following signs:

Ear

Patients with orbital cellulitis may present with signs which are suggestive of inner or middle ear infection:

Nose

Patients with orbital cellulitis may present with signs which are suggestive of sinusitis:

Throat/Oral

Patients with orbital cellulitis may present with signs which are suggestive of oral, pharyngeal, or upper respiratory tract infections:

Neck

Patients with orbital cellulitis may present with tender cervical lymph nodes, which are suggestive of regional infection.

Lung

Patients with orbital cellulitis may present with wheezing or coughing, which are suggestive of upper respiratory tract infection.

References

  1. 1.0 1.1 1.2 American Academy of Ophthalmology EyeWiki (2015)http://eyewiki.aao.org/Orbital_Cellulitis
  2. 2.0 2.1 Stanford Orbital Cellulitis Summary (2011)http://peds.stanford.edu/Rotations/blue_team/documents/Periorbital_and_Orbital_Cellulitis_Summary.pdf
  3. 3.0 3.1 Lam Choi VB, Yuen HK, Biswas J, Yanoff M (2011). "Update in pathological diagnosis of orbital infections and inflammations". Middle East Afr J Ophthalmol. 18 (4): 268–76. doi:10.4103/0974-9233.90127. PMC 3249811. PMID 22224014.
  4. 4.0 4.1 Chaudhry IA, Al-Rashed W, Arat YO (2012). "The hot orbit: orbital cellulitis". Middle East Afr J Ophthalmol. 19 (1): 34–42. doi:10.4103/0974-9233.92114. PMC 3277022. PMID 22346113.
  5. 5.0 5.1 Hasanee K, Sharma S (2004). "Ophthaproblem. Orbital cellulitis". Can Fam Physician. 50: 359, 365, 367. PMC 2214559. PMID 15318671.
  6. 6.0 6.1 Merck Manual Professional Version (2016)https://www.merckmanuals.com/professional/eye-disorders/orbital-diseases/preseptal-and-orbital-cellulitis

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