小结
定义
病史和体格检查
关键诊断因素
- recent sinus infection
- recent eyelid injury
- redness and swelling of eye
- ocular pain
- decreased vision
- proptosis
- eyelid edema
- insect bite on eyelid
- stye or chalazion
- ear or facial infection
- ophthalmoplegia and diplopia
其他诊断因素
- orbital trauma
- skin infection
- chemosis
- tenderness around eye
- fever
- eyelid erythema
- elevated intraocular pressure
- headache
- malaise
- previous dental infection or dental work
- orbital fracture
- foreign body in eye or orbit
- drowsiness
- nausea/vomiting
- nasal discharge
危险因素
- sinusitis
- young age
- male sex
- lack of Hib vaccine in children
诊断性检查
首要检查
- clinical exam
- CT sinus and orbits with contrast medium
- WBC count
需考虑的检查
- blood culture
- microbiology swabs (conjunctiva, nasopharnyx, external wounds)
- MRI head and orbits with contrast medium
- Orbital ultrasonography
- lumbar puncture
治疗流程
periorbital cellulitis: causative organism not identified
periorbital cellulitis: causative organism identified
orbital cellulitis: causative organism not identified
orbital cellulitis: causative organism identified
撰稿人
作者
Sudarshan Srivatsan, MD
Oculoplastics Fellow
Moran Eye Center
University of Utah
Salt Lake City
UT
利益声明
SS declares that he has no competing interests.
Robert Kersten, MD, FACS, FASOPRS
Professor of Clinical Ophthalmology
Division Chief, Oculoplastics
Moran Eye Center
University of Utah
Salt Lake City
UT
利益声明
RK declares that he has no competing interests.
鸣谢
Dr Sudarshan Srivatsan and Dr Robert Kersten would like to gratefully acknowledge Dr Sandra Lora Cremers, Dr Sarosh Janjua, and Dr H. Jane Kim, previous contributors to this topic. SLC, SJ and HJK declare that they have no competing interests.
同行评议者
David M. Ozog, MD
Director of Cosmetic Dermatology
Department of Dermatology
Cosmetic and Procedural Dermatology
Henry Ford Health System
Detroit
MI
利益声明
DMO declares that he has no competing interests.
I-Hui (Elaine) Wu, MD
Resident
Wilmer Eye Institute
Baltimore
MD
利益声明
IW declares that she has no competing interests.
Cristine Radojicic, MD
Staff Physician
Cleveland Clinic
Cleveland
OH
利益声明
CR declares that she has no competing interests.
Jonathan Smith, MD
Specialist Registrar in Ophthalmology
Royal Victoria Infirmary
Newcastle
UK
利益声明
JS declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Robinson A, Beech T, McDermott AL, et al. Investigation and management of adult periorbital or orbital cellulitis. J Laryngol Otol. 2007;121:545-7. 摘要
Chandler JR, Langenbrunner DJ, Stevens ER. The pathogenesis of orbital complications in acute sinusitis. Laryngoscope. 1970;80:1414-1428. 摘要
Hamed-Azzam S, AlHashash I, Briscoe D, et al. Common orbital infections ~ state of the art ~ Part I. J Ophthalmic Vis Res. 2018 Apr-Jun;13(2):175-82.全文 摘要
American Academy of Ophthalmology. Orbital cellulitis. Apr 2024 [internet publication].全文
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Orbital pseudotumor (idiopathic orbital inflammation)
- Thyroid eye disease
- Panophthalmitis
更多 鉴别诊断指南
- Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)
- Appropriateness criteria: orbital imaging and visual loss - child
更多 指南患者教育信息
Cellulitis and erysipelas
Sinusitis
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