ORBITAL MANAGEMENT GUIDELINE – FOR ADULTS & PAEDS

Authors: Stephen Ball, Arthur Okonkwo, Steven Powell, Sean Carrie Orbital cellulitis management guideline – For Adults & Paeds

Is it limited to Preseptal Cellulitis?

 i.e. only & eye not involved

 Oral Co-amoxiclav

( if penicillin allergic)  Consider treating as an outpatient with review in eye casualty in 24-48 hours

No

Indication for admission – any of:  Clinical suspicion of post-septal cellulitis Baseline Investigations  Pyrexia  FBC, CRP, lactate (& if  Immunocompromised pyrexia)  Had 36-48 hours of oral antibiotics  Endonasal swab  <12 months old  unable to assess eye due to swelling

Yes

Medical management Discharge  ADULTS – iv Tazocin (allergy; Iv clindamycin & iv ciprofloxacin)  Discharge once swelling  PAEDS – iv co-amoxiclav (allergy; iv cefuroxime & has resolved and metronidazole if mild allergy - other allergy discuss with micro) pyrexia settled with  IMMUNOCOMPROMISED - discuss all with microbiology/ID oral antibiotics;  Consider nasal Otrivine & nasal steroids -co-amoxiclav  4 hourly eye & neuro-observations -clindamycin if  Urgent assessment & daily review penicillin allergic  Urgent Otolaryngology assessment & daily review

Yes

Indication for imaging  CNS involvement NO - Discuss  Unable to examine eye/open with  Eye signs – any of: proptosis, restriction/pain microbiology/ID on , , RAPD, reduced visual acuity/colour vision/visual field, swelling No  Failure to improve or continued pyrexia after 36-48 hours IV antibiotics

Improvement in 36-48 hours

Contrast enhanced CT , Sinuses and Brain Continue medical management, rescan if failure to Orbital Collection No Orbital Collection improve after 36-48 Outpatient Treatment hours Admission

Surgical management Medical Management  Approach depends on local skill set o Evacuation of orbital pus Imaging o Drainage of paranasal sinus pus

Discuss any intracranial complication with both neurosurgery & Microbiology Surgical Management