Peri - Orbital Cellulitis
A true story in an Emergency Department
Story
45 years old male presented to the Emergency for ongoing facial swelling in the right side if the face, started around the eye and spreading. Total days were 3 days and associated fever and severe pain that area. He has lost his Right eye due to Retinoblastoma during childhood and was using a prosthesis, which he was stopped using it for few years.
At triage categorized him CAT 2, which means he needs to be seen by a doctor immediately (At least within 20 min). I will elaborate about triage procedure in Emergency department in a separated news letter.
So an Emergency doctor has seen the patient and examined and realized that there is a significant swelling in the Right side eye and upper part of the face in the same side with redness. There was no any discharge and clinically diagnosed as “Peri orbital Cellulitis”
What is Cellulitis
It is a bacterial infection of the skin. It can be anywhere in the body. Mostly and commonly people are coming with lower limb cellulitis. One reason is because it is more common to breach skin of the legs compared to other areas and when that happens these bugs can go inside of the skin and grow and start to infect the skin. Most common two bacterias are Streptococcus and Staphyloccocus.
Peri orbital Cellulitis mean that skin infection around the eye. We are worried as clinicians is that this infection can extend to the eye, but it is not common. However if it is involving the eye it is called Orbital Cellulitis and it can cause double vision, pain, and sometimes blindness.
What Happened Next?
So above mentioned patient had a CT scan of the face to find out how far the cellulitis is extending and to find out whether there is collection, which need to be drained if found out. The CT came as there is no collection and blood showed there is increased inflammatory markers. Blood culture also has taken, (Special test which will check for growth of bacteria in blood, which will take more than 24 hours and if a bug started to grow Microbiologist will check for the antibiotic sensitivity.
The patient was treated one dose intra venous antibiotic and sent home with oral antibiotic. But the next day the blood culture result came as positive for Streptococcus and patient has been asked to come to Emergeency department again,
This time patient also complained that the swelling has increased and it is spreading around the other eye too. However started on IV antibiotics and admitted for further treatment. If the eye also involved need to take ophthalmology input as well, but his case he does not have Right eye as it was removed in childhood due to a condition called Retinoblastoma
What to Learn
Risk factors are Diabetes, Immunocompromised (Such as organ transplant and on steroids), Trauma to face (Skin breach)
When suspected immediately seek medical advice
Orbital Cellulitis is more dangerous and it even can lose your life
Do not wait till it spread if happens it is difficult to treat.
Do not do native treatments such as applying oil, creams and plants
Important topic! Keep it up.