Concluded Case

orbital cellulitis

25 yrs female came to my opd with C/c of pain ,inability to open eye , swelling of RE for 15 days.h/o watering from same eye for 3 yrs. o/e signs of acute inflammation were obvious and diagnosis of orbital cellulitis was very much easier following chronic dacryocystitis. now discussion is on on differential diagnosis and management line...

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I gave oral antibiotics,anti inflammatory , diamox ,topical antibiotic with lubricant and dry hot fomentation for 3 days but pt didn't respond to this therapy.on third day I replaced the oral antibiotic with I/V ceftriaxone with sulbactam (1.5gm) bd, added oral deflazacort 30 mg rest same.pt responded very well....now I am waiting for 3rd follow up on 9th day with complete recovery and plan for DCR with silicone tube(un attended dacryocystitis the culprit of the condition of pt).

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Differential diagnosis includes preseptal ( periorbital) cellulitis, suppurative chalazion, acute dacryocystitis and tendonitis. Personally I consider this case as preseptal cellulitis Five points should be considered 1. Lid oedema -much more in preseptal cellulitis 2. Proptosis-absent or minimum in preseptal cellulitis 3. Chemosis -marked in orbital and minimum in preseptal cellulitis 4. Visual acuity- normal in preseptal cellulitis 5.Ophthalmoplegia- absent in preseptal cellulitis.

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DIFFERENTIAL DIAGNOSIS:- Idiopathic inflammation/specific inflammation (e.g. orbital pseudo tumor, granulomatosis with polyangiitis, sarcoidois) Neoplasia (e.g. leukemia, rhabdomyosarcoma, lymphoma, retinoblastoma, metastatic carcinoma) Trauma (e.g.retrobulbar hemorrhage, orbital emphysema) Systemic diseases (e.g sickle cell disease with bony infarcts and subperiosteal hematomas) Endocrine disorders (e.g. thyroid ophthalmopathy)

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Acute dacryocystitis: Rx : . amoxicillin with dicloxacillin. . Paracetamol . Topical antibiotics e/drops frequently. Hot fomentations . . I& d of lacrimal abscess sos. . With a h/o 15 days , & nontoxic looking face , a dx of orbital cellulitis is less likely.

I gave oral antibiotics,anti inflammatory , diamox ,topical antibiotic with lubricant and dry hot fomentation for 3 days but pt didn't respond to this therapy.on third day I replaced the oral antibiotic with I/V ceftriaxone with sulbactam (1.5gm) bd, added oral deflazacort 30 mg rest same.pt responded very well....now I am waiting for 3rd follow up on 9th day with complete recovery and plan for DCR with silicone tube(un attended dacryocystitis the culprit of the condition of pt).

Preseptal cellulitis advancing towards orbital cellulitis inj is swab for c/s is purezone I1 gm I/v 12 hourly Tab augmentin 8 hourly . After c/finding adjust antibiotic Ibuprofen 600mg bd

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

It is clinically obvious case of orbital cellulitis. T/T Higher ANTIBIOTICS NSAID,ANTIBIOTICS DROPS N LOCAL CARE.

Peri Orbital Cellulitis! IV Cefataxim for a week until it resolves! Anti inflammatory agents like Aceclofenac Paracetamol Ofloxacine eye drops

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Start on intravenous antibiotics metronidazole Systemic antibiotics Nsaids Topical antibiotics

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