PNR Face 01
History
8 yo M with left eye swelling and redness for 5 days, being treated for bacterial stye
Major Findings
- Left post-septal orbital cellulitis with subperiosteal abscess and medial rectus myositis
- Left eye proptosis
Teaching Points
The orbital septum is a membrane (difficult to see on CT) connecting the orbital rim to the eyelids and separates intra-orbital fat from eyelid fat.
- If soft tissue swelling remains anterior to this septal line, it is called pre-septal (periorbital) cellulitis - may be managed with PO antibiotics
- If swelling extends posterior to this line into the intraorbital fat (as in this case), it is called post-septal (orbital) cellulitis - requires IV antibiotics
Complications to look out for:
- Subperiosteal abscess
- Intraorbital abscess
- Proptosis
- Thrombosis of the superior ophthalmic vein
- Intracranial spread of infection
How to measure proptosis using the interzygomatic line: 
Great review article on orbital emergencies:
Accession: CL0679
Study description: CT ORBITS/TEMPORAL BON
