The following is a summary of “High risk and low prevalence diseases: Orbital cellulitis,” published in the June 2023 issue of Emergency Medicine by Pelletier, et al.

Orbital cellulitis is an infrequent yet severe condition with the potential for significant morbidity. For a study, researchers sought to emphasize the essential aspects of orbital cellulitis, including its presentation, diagnosis, and management in the emergency department (ED), based on the latest available evidence.

Orbital cellulitis is an infection affecting the globe and surrounding soft tissues posterior to the orbital septum. The condition commonly arises from the spread of infection from sinusitis, although it can also result from local trauma or dental infections. Pediatric patients were more commonly affected compared to adults. In the ED setting, it was crucial for clinicians to initially assess and manage other critical complications that may threaten eyesight, such as orbital compartment syndrome (OCS). 

After addressing immediate concerns, conducting a focused eye examination becomes essential. While the diagnosis of orbital cellulitis primarily relies on clinical evaluation, computed tomography (CT) of the brain and orbits with and without contrast plays a crucial role in evaluating potential complications like abscesses or intracranial extension. In cases where CT results are inconclusive, magnetic resonance imaging (MRI) of the brain and orbits with and without contrast should be considered. 

Point-of-care ultrasound (POCUS) may offer utility in differentiating between preseptal and orbital cellulitis, but it cannot fully exclude the possibility of intracranial extension of the infection. Managing orbital cellulitis involves timely administering broad-spectrum antibiotics and consultation with ophthalmology. The use of steroids remained a topic of debate. Neurosurgery consultation is imperative if the infection has extended to the intracranial area (e.g., cavernous sinus thrombosis, abscess, or meningitis).

An in-depth understanding of orbital cellulitis is crucial for emergency clinicians to diagnose and effectively manage the potentially vision-threatening infectious condition promptly.

Source: sciencedirect.com/science/article/abs/pii/S073567572300092X