Infection around the eyeball that involves the tissues behind the orbital septum

PC

Key features differentiating it from periorbital cellulitis:

• Pain on eye movement
• Reduced eye movements
• changes in vision
• abnormal pupil reactions
• Proptosis (forward movement of the eyeball

Clinical examination - involving complete ophthalmological assessment – Decreased vision, afferent pupillary defect, proptosis, dysmotility, oedema, erythema.

Investigations

• Full blood count – WBC elevated, raised inflammatory markers.
• CT with contrast – Inflammation of the orbital tissues deep to the septum, sinusitis.
• Blood culture and microbiological swab to determine the organism. Most common bacterial causes – Streptococcus, Staphylococcus aureus, Haemophilus influenzae B.

Management

This is a medical emergency that requires admission and IV antibiotics. They may require surgical drainage if an abscess forms.