Medical DISers.......please tell me EVERYTHING you know about periorbital cellulitis

MELSMICE

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Feb 22, 2002
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Bear with me during this post..............it's been a long few days.

One of my DD's has orbital cellulitis. She had this when she 6 & again when she was 7. First time they tried to treat it with oral antibiotics. She ended up in the hospital on IV antibiotics. Second time I insisted she just be admitted to the hospital. We haven't had a recurrence for 7 years now.

Fast forward to Sunday & her eye is starting to get red. Put on her topical eurythromycin (sp?) ointment. Continues to swell & redden during the day. Take her to the Dr. as soon as they open Monday. She is already on amoxycillin for a throat/sinus/ear infection. Take her off amoxycillin & put her on Cipro (ciprofloxacin). (have read on line that the sinus infection, etc. can turn into orbital cellulitis)

Wake up this morning & eye is worse. Call Dr. & take her to ER. They give her an IV does of Ceftriaxone & send her home with instructions to continiue the Cipro she already has, get an appt. with her opthamologist, warm compresses, check for eye pain when moving eye, blah, blah, blah.

I guess my questions/concerns are...............should I have insisted we remain in the hospital so they could continue to check & evaluate her? I was told that ceftriaxone was only given once every 24 hours & that if it is worse by tomorrow morning to bring her back in. My ped is not in the office tomorrow but said if she should wake up & it's worse to take her back immediately.

I know how serious this can be if not treated properly. Part of me says if she can't get the IV until tomorrow morning that we are better off at home anyway, but another part of me says I should have insisted she be admitted.

Any info that anyone can give on orbital cellulitis is appreciated. As she has had it before we do have some experience, but I am not an MD - all my info comes from listening, questioning & what I read on line.
 
i think the correct diagnosis is probably "periorbital cellulits". google it, see what you learn. it is an infection of the skin surrounding the eye. good luck, I hope all turns out well.
 
Not to scare you.... Information found on WebMD

Symptoms of cellulitis in the eye area
If cellulitis affects the eye area, you may experience pain in and around the eye, restricted eye movement, and disturbances in your vision. Cellulitis affecting the eye requires urgent treatment to prevent permanent eye damage, blindness, or spread of the infection to the brain (meningitis).

What is cellulitis?
Cellulitis is a skin infection caused by bacteria. The infection extends into the tissues below the outer layer of skin (subcutaneous tissue). It most often develops anywhere the skin has been broken-often from a cut, burn, or an insect bite. The infection spreads from the skin to underlying tissues. In severe cases, it can spread quickly, within hours or days. Cellulitis is usually not contagious.

What causes cellulitis?
Cellulitis is caused by bacteria (usually Streptococcus or Staphylococcus). Some people are at risk for infection by other types of bacteria that result in cellulitis. At-risk groups include people with impaired immune systems and people who handle fish, meat, poultry, or soil without using gloves.

What increases my risk of cellulitis?
You may be at increased risk for cellulitis if you have:

A cut or injury to the skin, a surgical wound, a skin infection, a burn, or an animal or insect bite.
Skin lesions, such as ulcers, eczema, psoriasis, or a fungal infection such as athlete's foot. One study found that inflammation caused by toes rubbing together (toe-web intertrigo) is often a cause of cellulitis in the leg, and that treating this skin inflammation could prevent cellulitis.1
Certain medical conditions, such as a circulatory disease, fluid buildup in the body tissues (edema), an impaired immune system, diabetes, peripheral arterial disease, or being overweight.
Impaired lymphatic drainage or blood circulation after surgery, such as after having a breast removed (mastectomy) or having a vein removed from your leg for use in coronary bypass surgery.2, 3
Liposuction, which is a procedure to remove excess fat tissue.3
Injected illegal drugs under your skin.3
What are the symptoms of cellulitis?
Cellulitis can cause tenderness, pain, swelling, and redness at the site of the infection. Fever and chills are also common. Cellulitis can occur anywhere on the body. In adults, it often occurs on the legs, face, or arms. In children, it commonly develops on the face or around the anus. Facial infection requires immediate medical attention; antibiotics can help prevent a potentially dangerous eye infection.

Are there complications of cellulitis?
Complications such as bacteremia (presence of bacteria in the blood) or sepsis (body's response to widespread infection) can develop if the bacteria that cause cellulitis spread quickly through the body. Facial cellulitis infection can spread to the brain (meningitis). Other complications, such as thrombophlebitis or, rarely, gangrene, can also develop. If you are an older adult, have certain medical conditions such as diabetes or peripheral arterial disease, or have an impaired immune system, you are more likely to have complications. Your chances of the cellulitis coming back may also be higher.

How is cellulitis treated?
Antibiotics are the main treatment for cellulitis and are usually successful in curing the infection. Antibiotics can be taken either by mouth or intravenously (IV). If you have certain medical conditions that increase your risk of getting cellulitis, you can take antibiotics after a skin injury to help prevent the infection.

Treatment Overview
The intent of cellulitis treatment is to decrease the severity of the infection, speed up recovery, relieve pain and other symptoms, heal the skin, and prevent the infection from coming back.

Antibiotics are usually used to treat cellulitis. If the infection is limited to a small area, has not spread to the bloodstream or lymph system, and you don't have any other medical problems, antibiotics you take by mouth (oral) are effective. If the infection is more widespread, or if you're having a slow recovery on oral antibiotics, antibiotics may be used intravenously (IV) or by injection.

For cellulitis of the leg or arm, treatment also includes elevating the limb to reduce swelling and applying a sterile, saline-soaked dressing to aid healing and reduce pain.

Treatment for children depends on their age and which part of the body is infected. An antibiotic is usually given intravenously. Facial cellulitis in young children requires immediate treatment and responds well to antibiotics.6

Treatment sometimes requires a stay in the hospital. This is common if antibiotics must be given intravenously, but it is also considered if you have signs of complications such as a high fever, or if it will be difficult for you to have follow-up care with a health professional.

Medications used to treat cellulitis
Oral, topical (applied to the skin), or intravenous antibiotics may be used to treat cellulitis. The extent of the infection and its location help determine what type of antibiotic is used.

Oral antibiotics include penicillin or a similar medication such as dicloxacillin. For people who are allergic to penicillin, a cephalosporin, erythromycin, or vancomycin can be used.
Topical antibiotics include mupirocin, which has been found to be as effective as oral antibiotics for children with cellulitis in the area around the anus.4
Intravenous antibiotics may include nafcillin, levofloxacin, or cephalosporin.
Preventing a recurrence of cellulitis
Cellulitis tends to recur in people with certain medical conditions that can lead to skin breakdown, such as edema (fluid buildup), fungal or bacterial infections, diabetes, or peripheral arterial disease.

If you have edema, support stockings and good skin hygiene may reduce or eliminate recurrence of cellulitis.5
If you develop frequent fungal infections, regular use of antifungal medications may help reduce recurrent cellulitis.
If you are considered very high risk for recurring cellulitis, taking preventive antibiotics may help. A common course of preventive antibiotics is a dose of antibiotics every 2 weeks.7

Home Treatment
If you have cellulitis, follow your doctor's instructions for taking medication and for skin care. Other steps to help your recovery and keep cellulitis from coming back include the following:

Take all of your medication as prescribed.
Take care of your skin. Any measure that prevents injury to your skin will help to prevent cellulitis.
Elevate your affected leg or arm to reduce swelling. Apply a sterile, saline-soaked dressing to reduce pain.
Apply warm compresses to the affected area.
Use pain relievers as needed.
Use support stockings to prevent fluid buildup.
Take steps to treat or prevent fungal infections, such as athlete's foot. If athlete's foot is hard to treat or recurs, ask your doctor about oral antifungal medications. For more information on treating this condition, see the topic Athlete's Foot.
Take care of your feet, especially if you have diabetes or other conditions that may increase the risk of infection.
Avoid touching possible sources of infection, such as ill family members and their belongings; raw fish, meat, or poultry; or soil, particularly when you have an area of broken skin.
When you have completed your course of medication, follow up with your doctor to verify that the infection is gone.


Hope this helps.... Hope she gets better soon :flower3:
 
One word...misery. Had it many times had to go on an outpatient IV for a week at a time. If left untreated it can spread to the brain...not good. Trust your instinct. If you feel something is not right take her in:thumbsup2
 

Thanks for the responses.

I have been reading & rereading everything I've found on-line, including all the information about the antibiotics she is taking. I guess we were lucky in that she has had this before & are aware of how serious it can be if not treated immediately.

We've checked eye movement numerous times since we got home (around 1 p.m) & she has another warm compress on it right now. She just took a does of cipro. It doesn't look any worse right now & to me it looks a little less red, which I'm assuming is a good sign.

She did say it is watering, so now we are checking to make sure there is not "puss" (I hate that word) coming out of it.

Thanks again for the responses.
 
i think the correct diagnosis is probably "periorbital cellulits". google it, see what you learn. it is an infection of the skin surrounding the eye. good luck, I hope all turns out well.
Thanks - I changed my thread title.
 
My Ds had it when he was 9 months old. We were in the hospital for 5 days. They thought it would be 7-10 but he responded very well the the IV antibiotics. They also did a CAT scan to see if there was a blockage. There was not so they did not need to do surgery. I don't know how bad your DD's is but I know it can be serious and I would keep talking to the dr. Maybe you need to see if you can go to a specialist to see why it keeps happening. My dr. also had us go to an opthamoligist (sp) for 3 yrs after to check to see if the eye was ok and that there were no other problems. Good luck and let us know what happens.
 
Normally we tend to treat periorbital cellulitis as a ophthalmological emergency and refer that day for assessment and I.V. antibiotics. I wouldn't dream of letting anyone home in whom I suspected that diagnosis. Maybe it is different in the US?? I would want I.V. Ab's if I had that condition and I am a physician.
 
Normally we tend to treat periorbital cellulitis as a ophthalmological emergency and refer that day for assessment and I.V. antibiotics. I wouldn't dream of letting anyone home in whom I suspected that diagnosis. Maybe it is different in the US?? I would want I.V. Ab's if I had that condition and I am a physician.

At the Children's Hospital this would be standard of care.
 
Normally we tend to treat periorbital cellulitis as a ophthalmological emergency and refer that day for assessment and I.V. antibiotics. I wouldn't dream of letting anyone home in whom I suspected that diagnosis. Maybe it is different in the US?? I would want I.V. Ab's if I had that condition and I am a physician.
When she had it at ages 6 & 7 the IV antibiotics were administered every 8 hours & we stayed in the hospital.

I did question this morning why we wouldn't be admitted so she could receive more doses via IV, assuming it was an 8-hour cycle. That's when they said that the Ceftriaxone antibiotic she was receiving could only be administered every 24 hours.

She started receiving it at 9:30 a.m. this morning (Tuesday). She took the Cipro at 7:15 p.m. She just went to bed & I rechecked the eye again. It is not worse & looks as if the swelling may have gone down a little bit (it's hard to tell because I've looked at it so much). I will be checking her during the night. We get up around 6 a.m. If it looks even a tiny bit worse we will be off to the hospital again for another round of IV antibiotics and the insistence that she be admitted.

Also, I've looked at some of the pictures they show on-line & DD's is not as bad as the pictures. The swelling is only on the bottom part of her upper lid. There is no swelling or pain around the perimeter of tye eye, cheekbone, foreheard or near her nose.

My concern now is that the oral antibiotic will continue to work as well as the IV - if not, we'll be back at the hospital in the morning & I'll insist she be admitted.

Thanks for all your concerns. I'll keep you posted.
 














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