Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA.
Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA.
Am J Emerg Med. 2023 Jun;68:1-9. doi: 10.1016/j.ajem.2023.02.024. Epub 2023 Feb 26.
Orbital cellulitis is an uncommon but serious condition that carries with it a potential for significant morbidity.
This review highlights the pearls and pitfalls of orbital cellulitis, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.
Orbital cellulitis refers to infection of the globe and surrounding soft tissues posterior to the orbital septum. Orbital cellulitis is typically caused by local spread from sinusitis but can also be caused by local trauma or dental infection. It is more common in pediatric patients compared to adults. Emergency clinicians should first assess for and manage other critical, sight-threatening complications such as orbital compartment syndrome (OCS). Following this assessment, a focused eye examination is necessary. Though orbital cellulitis is primarily a clinical diagnosis, computed tomography (CT) of the brain and orbits with and without contrast is critical for evaluation of complications such as abscess or intracranial extension. Magnetic resonance imaging (MRI) of the brain and orbits with and without contrast should be performed in cases of suspected orbital cellulitis in which CT is non-diagnostic. While point-of-care ultrasound (POCUS) may be useful in differentiating preseptal from orbital cellulitis, it cannot exclude intracranial extension of infection. Management includes early administration of broad-spectrum antibiotics and ophthalmology consultation. The use of steroids is controversial. In cases of intracranial extension of infection (e.g., cavernous sinus thrombosis, abscess, or meningitis), neurosurgery should be consulted.
An understanding of orbital cellulitis can assist emergency clinicians in diagnosing and managing this sight-threatening infectious process.
眶蜂窝织炎是一种不常见但严重的疾病，有发生严重并发症的风险。
本综述重点介绍眶蜂窝织炎的要点和陷阱，包括根据现有证据在急诊科的表现、诊断和治疗。
眶蜂窝织炎是指眶隔后的眼球和周围软组织感染。眶蜂窝织炎通常由鼻窦感染引起，但也可由局部创伤或牙齿感染引起。与成人相比，儿童患者更为常见。急诊临床医生应首先评估和处理其他严重的、威胁视力的并发症，如眶隔综合征（OCS）。在进行此评估后，需要进行有针对性的眼部检查。尽管眶蜂窝织炎主要是临床诊断，但脑和眼眶的 CT 平扫和增强检查对于评估脓肿或颅内扩展等并发症至关重要。在 CT 检查结果不明确的疑似眶蜂窝织炎病例中，应进行脑和眼眶的 MRI 平扫和增强检查。在区分眶隔前和眶蜂窝织炎时，即时超声（POCUS）可能有用，但不能排除感染的颅内扩展。治疗包括早期使用广谱抗生素和眼科会诊。皮质类固醇的使用存在争议。对于感染的颅内扩展（例如海绵窦血栓形成、脓肿或脑膜炎），应咨询神经外科。
了解眶蜂窝织炎可以帮助急诊临床医生诊断和治疗这种威胁视力的感染性疾病。
