Periorbital Edema

Periorbital edema is frequently reported by parents via telephone. Unless the cause is obvious and benign, an immediate evaluation is warranted.

Differential Diagnosis

• Periorbital cellulitis
  –Also described as preseptal cellulitis (infection is anterior to the orbital septum and thus does not affect the orbit or globe)
  –Usual pathogens are streptococcal species, Staphylococcus aureus, and Haemophilus influenzae

• Orbital cellulitis
  –Also described as postseptal and affects the preseptal structures as well as the extraocular muscles and the optic nerve
  –Bacterial pathogens are the same as periorbital cellulitis and may reflect direct spread
  –May be accompanied by orbital abscess and may spread via the sinuses to the brain

• Other infections
  –Conjunctivitis
  –Sinusitis
  –Dental abscess
• Allergic reaction
  –Conjunctivitis
  –Urticaria/angioedema
  –Drug reaction
• Local ocular causes
  –Insect bites
  –Contact dermatitis
  –Trauma
  –Foreign body
• Systemic disorders with generalized edema
  –Hypoproteinemia
  –Renal disease
  –Congestive heart failure
• Malignancy
  –Neuroblastomas: Associated with ecchymoses, “raccoon eyes,” and proptosis
  –Leukemia: Associated with fever, fatigue, anemia, bone pain, lymphadenopathy, splenomegaly

Workup and Diagnosis

• History
  –Onset, duration, progression of symptoms
  –Presence of pain or pruritus
  –History of trauma
  –Systemic symptoms such as fever
• Physical exam
  –Temperature, vital signs, growth parameters
  –Proptosis
  –Ocular range of motion
  –Full physical exam including heart, lung, and extremities
• Labs
  –Electrolytes, BUN, creatinine
  –Serum protein and albumin
  –CBC and blood culture if infection is suspected
  –ESR, LDH if malignancy is suspected
• Studies
  –CT to distinguish periorbital cellulitis from orbital cellulitis
  –CT or MRI to discover orbital or cranial tumors
  –CXR if CHF is suspected
  –Renal ultrasound to evaluate the architecture of the kidneys, Doppler to evaluate renal flow, DMSA to evaluate renal parenchyma if edema is generalized

Treatment

• Periorbital and orbital cellulitis are treated with IV antibiotics
• Orbital or subperiosteal abscess accompanying orbital cellulitis must be drained operatively
• Conjunctivitis, sinusitis, and dental abscess can usually be treated with oral antibiotics
• Mild allergic reactions are treated with antihistamines; more severe reactions may require epinephrine and/or systemic steroids
• Renal disease should be referred to a nephrologist for evaluation (frequently involving biopsy) and treatment
• Congestive heart failure is initially treated with diuretics and inotropic agents; pursuit of etiology and definitive treatment usually involves a cardiologist
• Suspected or discovered malignancies must be immediately referred to an oncologist

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Ear swelling

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Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Ear swelling

• Back to symptom: Ear swelling: Introduction (review 26 causes)
• Next Book Extract About Ear swelling: EARACHE (Differential Diagnosis in Primary Care)
• All Book Extracts: All Online Book Extracts for Ear swelling

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: EARACHE (Differential Diagnosis in Primary Care)

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