Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- recent sinus infection
- recent eyelid injury
- redness and swelling of eye
- ocular pain
- decreased vision
- proptosis
- eyelid oedema
- insect bite on eyelid
- stye or chalazion
- ear or facial infection
- ophthalmoplegia and diplopia
Other diagnostic factors
- orbital trauma
- skin infection
- chemosis
- tenderness around eye
- fever
- eyelid erythema
- elevated intra-ocular pressure
- headache
- malaise
- previous dental infection or dental work
- orbital fracture
- foreign body in eye or orbit
- drowsiness
- nausea/vomiting
- nasal discharge
Diagnostic investigations
1st investigations to order
- clinical examination
- CT sinus and orbits with contrast medium
- WBC count
Investigations to consider
- blood culture
- microbiology swab (conjunctiva, nasopharynx, external wounds)
- MRI head and orbits with contrast medium
- Orbital ultrasonography
- lumbar puncture
Treatment algorithm
Contributors
Authors
Sudarshan Srivatsan, MD
Oculoplastics Fellow
Moran Eye Center
University of Utah
Salt Lake City
UT
Disclosures
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
Disclosures
RK declares that he has no competing interests.
Acknowledgements
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.
Peer reviewers
David M. Ozog, MD
Director of Cosmetic Dermatology
Department of Dermatology
Cosmetic and Procedural Dermatology
Henry Ford Health System
Detroit
MI
Disclosures
DMO declares that he has no competing interests.
I-Hui (Elaine) Wu, MD
Resident
Wilmer Eye Institute
Baltimore
MD
Disclosures
IW declares that she has no competing interests.
Cristine Radojicic, MD
Staff Physician
Cleveland Clinic
Cleveland
OH
Disclosures
CR declares that she has no competing interests.
Jonathan Smith, MD
Specialist Registrar in Ophthalmology
Royal Victoria Infirmary
Newcastle
UK
Disclosures
JS declares that he has no competing interests.
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