ANKHWALA - SEQ ORBIT

A 11-year-old female reported in eye OPD with swollen and red left eye and it seemed to be worsening. The patient also stated that it had been more difficult to open her left eye and there had been some matting on her eyelids. She also noticed diplopia and gave history of left nasal pain 03 days prior to presentation. (1+1+0.5)

a. Describe Clinical Presentation of orbital cellulitis

b. Enlist Common Causes of orbital Cellulitis

c. How will you differentiate between presential and orbital cellulitis

d. How will you manage the case?

e. Enumerate complications of the disease

A. Clinical Presentation of Orbital Cellulitis

History

Recent upper respiratory tract infection or sinusitis (especially ethmoid sinusitis).
Rapid progression of eyelid swelling, redness, and pain.
Symptoms may include headache, fever, malaise, nasal discharge, or sinus tenderness

Local Ocular Signs

Eyelid edema and erythema (often severe).
Tenderness of eyelids and orbit.
Painful and restricted ocular movements (ophthalmoplegia).
Proptosis (eye bulging forward).
Chemosis (conjunctival swelling).
Severe conjunctival congestion.
Visual impairment: decreased acuity, diplopia, or relative afferent pupillary defect if optic nerve is involved

Systemic Features

Fever and leukocytosis (common in children).
Lethargy or malaise.
Severe cases may show headache, nausea, vomiting, or altered sensorium, suggesting intracranial extension.

Red Flag Signs (Differentiate from Preseptal Cellulitis)

Pain with eye movements (not seen in preseptal cellulitis).
Restricted ocular motility.
Proptosis.
Visual loss or diplopia.
Systemic toxicity (fever, malaise)

b. Causes of Orbital Cellulitis

Paranasal sinusitis (especially ethmoid)
Spread from preseptal cellulitis or dacryocystitis
Dental infections
Trauma or post‑surgical infection
Hematogenous spread from systemic infection

Differentiation between Preseptal and Orbital Cellulitis

Location:

Preseptal cellulitis is an infection anterior to the orbital septum, while orbital cellulitis occurs posterior to the orbital septum.

Eye movements:

In preseptal cellulitis, eye movements are normal. In orbital cellulitis, they are painful and restricted.

Proptosis:

Absent in preseptal cellulitis, but present in orbital cellulitis.

Vision:

Normal in preseptal cellulitis, but may be reduced in orbital cellulitis.

Diplopia:

Absent in preseptal cellulitis, but present in orbital cellulitis.

Systemic signs:

Usually mild in preseptal cellulitis, but orbital cellulitis often presents with fever and malaise.

Eyelid swelling/redness:

Present in both conditions, but orbital cellulitis shows additional orbital signs.

b. Management of the Case

The presence of diplopia, worsening swelling, difficulty opening the eye, and nasal pain suggests orbital cellulitis.

Steps:

Hospital admission – orbital cellulitis is an emergency.
Investigations:
- Complete blood count, blood cultures
- Contrast CT/MRI of orbit and paranasal sinuses

Medical management:

Intravenous broad‑spectrum antibiotics (covering staphylococcus, streptococcus, H. influenzae, and anaerobes)
Analgesics and antipyretics
Nasal decongestants if sinusitis is present

Surgical management (if indicated):

Drainage of orbital or subperiosteal abscess
Drainage of paranasal sinus infection (ENT referral)

Monitoring: Regular assessment of vision, pupillary reactions, and ocular motility.

Complications of Orbital Cellulitis

Ocular complications:
- Vision loss (optic nerve compression, ischemia)
- Exposure keratopathy
- Ophthalmoplegia

Intracranial complications:

Cavernous sinus thrombosis
Meningitis
Brain abscess
Subdural empyema

Systemic complications:

Sepsis

Q. a seven year old child with upper respiratory infection develops lid swelling and pain right eye. the right eyelid are tender to touch and not opening completely. the eye is severly congested and there is restriction of ocular movement in this eye. (2+3)

a. what is diagnosis

b, how will you manage this case

Q. A 45 year old female is on heavy dose of a steroids for her acute kidney disease. She reports in emergency with 3 days history of painful swelling in the left eye on temporal sclera followed by sudden severe swelling of the orbit, lid closure and inability to move the eyeball in any direction. (1+2+2)

a) Give most likely diagnosis.

b) Give THREE relevant investigations.

c) How it will be treated. What are the complications?

A 57 years-old patient presented with an acute left proptosis and maxilla swelling. On ocular examination there was marked restriction of the left ocular movement in all directions. There was left non-axial proptosis with marked conjunctival vessel dilation and massive chemosis. (1+2+2)

a. What is D/D?

b. What are clinical features of thyroid eye disease?

c. How will you manage a case of proptosis?

Q. A 30 -year old lady presents with mild ocular pain, staring and frightened appearance of eyes. There is history of profuse sweating palpitations and weight loss. Visual acuity is 6/6 both eyes and there is congestion in conjunctiva. (1+2+2)

a. what is most probable diagnosis

b. how will you examine and investigate this case

c. what is management at this stage of disease.

Q. 2. give two most important differential diagnosis in this case

Q. a young boy while playing cricket is hit by a ball on his right face. he complains of diplopia and crepitations around orbit. (2+1+2)

a. what is diagnosis

b. what sign you will see on X-ray of orbit

c. how will you manage this case

Q . 11 year child came in OPD with acute swelling of his left eyeball.This is associated with pain ,discomfort on extraocular movements, and decreased vision.O/E RAPD is present?

a) What is your differential diagnosis? (1+1+2)

b) How will you investigate this patient?

c) What are the complications of the disease?

Q: A 54 years male presented with outwards bulging of the right eyeball for last 6 months. On clinical examination, a mild RAPD was present. CT scan showed a space occupying lesion in the orbital cavity; (2+1.5+1.5)

a) How will you differentiate between cavernous heamangioma and optic nerve glioma?

b) What are the causes of bilateral proptosis. Name at least four? c) What are the different methods to measure proptosis?

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A. Clinical Presentation of Orbital Cellulitis

History

Recent upper respiratory tract infection or sinusitis (especially ethmoid sinusitis).

Rapid progression of eyelid swelling, redness, and pain.

Symptoms may include headache, fever, malaise, nasal discharge, or sinus tenderness

Local Ocular Signs

Eyelid edema and erythema (often severe).

Tenderness of eyelids and orbit.

Painful and restricted ocular movements (ophthalmoplegia).

Proptosis (eye bulging forward).

Chemosis (conjunctival swelling).

Severe conjunctival congestion.

Visual impairment: decreased acuity, diplopia, or relative afferent pupillary defect if optic nerve is involved

Systemic Features

Fever and leukocytosis (common in children).

Lethargy or malaise.

Severe cases may show headache, nausea, vomiting, or altered sensorium, suggesting intracranial extension.

Red Flag Signs (Differentiate from Preseptal Cellulitis)

Pain with eye movements (not seen in preseptal cellulitis).

Restricted ocular motility.

Proptosis.

Visual loss or diplopia.

Systemic toxicity (fever, malaise)

b. Causes of Orbital Cellulitis

b. Management of the Case

Complications of Orbital Cellulitis