Ophthalmological Emergencies Archives - Emergency Medicine Kenya Foundation

Periorbital and Orbital Cellulitis can be difficult to distinguish from initially. Know that both have a good chance of improving with IV antibiotics.
Not every child with preseptal/periorbital cellulitis requires a CT in the ED to rule-out orbital involvement.
- If there is no proptosis and normal eye movement, IV antibiotics may be sufficient.
- Hospitalization for close reassessments and eye exam can help determine if CT is eventually required.
Not every child with CT proven orbital cellulitis requires surgery! So don’t be mad when the ENT doctor recommends that the child is admitted for IV antibiotics to the Pediatric Service.
Bilateral is Bad! Think Cavernous Sinus Thrombosis!

History including specific eye involvement, sudden vs. chronic loss, pain, redness and discharge, trauma, other symptoms, and medication use are vital.
Physicians should be comfortable completing an appropriate history and physical examination including general inspection, visual acuity, pupils, EOMs, visual fields, fluorescein, lids, IOP, slit lamp, and US.
Emergent consultation is required for acute angle closure glaucoma, retinal detachment, CRAO, open globe, endophthalmitis, chemical burn, infectious keratitis, and giant cell arteritis.
Urgent referral is needed for uveitis, vitreous hemorrhage, acute maculopathy, CRVO, and optic neuritis.
Keep in mind other etiologies of vision loss including ischemia, stroke, toxin, infection, and functional.