Orbital cellulitis physical examination
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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.
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:
- Vital signs
- Best-corrected visual acuity(BCVA)
- Color vision assessment
- Proptosis measurements using Hertel exophthalmometry
- Visual field assessment
- Assessment of pupillary function with particular attention paid to the presence of a relative afferent pupillary defect (rAPD)
- Ocular motility and presence of pain with eye movements; additionally, there may be involvement of the III, IV, and VI cranial nerves in cases of cavernous sinus involvement.
- Orbit exam should include documentation of direction of displacement of the globe
- Measurement of intraocular pressure (IOP)
- Slit lamp test in cases of severe proptosis
- Dilated fundus exam to exclude optic neuropathy or retinal vascular occlusion
- Nasal sinus examination
- Otoscopy for presence of otitis media
- Oral examination for oropharyngeal infection and dentition
Patients with orbital cellulitis may present with some or all of the following signs:
Patients with orbital cellulitis usually appear ill and have marked inflammation and edema of the periorbital area.
Patients with orbital cellulitis may have the following vital signs, which are suggestive of infection:
Patients with orbital cellulitis may present with the following skin findings:
Patients with orbital cellulitis may have the following HEENT findings on physical examination:
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
Patients with orbital cellulitis may present with some or all the following signs:
- Periorbital edema and erythema
- Restricted or painful ocular movements
- Reduced visual acuity
- Increased intraocular pressure (IOP)
- Displacement of the globe
- Diminished visual field
- Signs of orbital trauma, or periorbital surgery (scars, injuries)
- Signs of periorbital insect bites
Patients with orbital cellulitis may present with signs which are suggestive of inner or middle ear infection:
- Erythema, edema and discharge present on otoscopy
- Reduced hearing
- Children may show signs of "tugging" on the affected ear
Patients with orbital cellulitis may present with signs which are suggestive of sinusitis:
- Nasal purulent discharge
- Erythema and edema of the nares, nasopharynx, and sinuses
- Painful sinuses upon applying pressure
Patients with orbital cellulitis may present with signs which are suggestive of oral, pharyngeal, or upper respiratory tract infections:
- Erythematous oropharynx
- Exudative tonsils
- Dental caries
- Tooth abscess
Patients with orbital cellulitis may present with tender cervical lymph nodes, which are suggestive of regional infection.
Patients with orbital cellulitis may present with wheezing or coughing, which are suggestive of upper respiratory tract infection.
- ↑ 1.0 1.1 1.2 American Academy of Ophthalmology EyeWiki (2015)http://eyewiki.aao.org/Orbital_Cellulitis
- ↑ 2.0 2.1 Stanford Orbital Cellulitis Summary (2011)http://peds.stanford.edu/Rotations/blue_team/documents/Periorbital_and_Orbital_Cellulitis_Summary.pdf
- ↑ 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.
- ↑ 4.0 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.
- ↑ 5.0 5.1 Hasanee K, Sharma S (2004). "Ophthaproblem. Orbital cellulitis". Can Fam Physician. 50: 359, 365, 367. PMC 2214559. PMID 15318671.
- ↑ 6.0 6.1 Merck Manual Professional Version (2016)https://www.merckmanuals.com/professional/eye-disorders/orbital-diseases/preseptal-and-orbital-cellulitis