study_ing
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1. how do we differentiate orbital cellulitis from cavernous sinus thrombosis clinically?
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| tolito
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in carven sinus throm, both eyes are affected but classically, one eye is affected before the other one. while orb cell tends to affect one eye.
i forget the other eye signs like pupil sizes, painful eye, accommodation
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| study_ing
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wud papilledema help? i read on an old post that papilledema points more towards CST.
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| study_ing
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History: Proptosis and ophthalmoplegia are the cardinal signs and symptoms of orbital cellulitis. The symptoms advance rapidly at an alarming rate and eventually lead to prostration. - Other common but variable accompanying signs include the following:
- Elevated intraocular pressure
- The above signs may be accompanied by the following:
Physical: - Proptosis and ophthalmoplegia may be accompanied by the following:
- Elevated intraocular pressure
- Orbital pain and tenderness are present early.
- Vision may be normal early, but it may become difficult to evaluate in very ill children with marked edema.
- Dark red discoloration of the eyelids, chemosis, hyperemia of the conjunctiva, and resistance to retropulsion of the globe may be present.
- Purulent nasal discharge may be present.
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| study_ing
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The early signs and symptoms of CST may not be specific. A patient who presents with headache and any cranial nerve findings should be potentially evaluated for CST. The most common signs of CST are related to the anatomical structures affected within the cavernous sinus
Physical: Other than the findings associated with the primary infection, the following signs are typical: - Periorbital edema may be the earliest physical finding.
- Chemosis results from occlusion of the ophthalmic veins.
- Lateral gaze palsy (isolated cranial nerve VI)
- Ptosis, mydriasis, and eye muscle weakness from cranial nerve III dysfunction
- Manifestations of increased retrobulbar pressure follow.
- Signs of increased intraocular pressure (IOP) may be observed.
- Pupillary responses are sluggish.
- Decreased visual acuity is common owing to increased IOP and traction on the optic nerve and central retinal artery.
- Hypoesthesia or hyperesthesia in dermatomes supplied by the V1 and V2 branches of the fifth cranial nerve
- Appearance of signs and symptoms in the contralateral eye is diagnostic of CST, although the process may remain confined to one eye.
- Meningeal signs, including nuchal rigidity and Kernig and Brudzinski signs, may be noted.
- Systemic signs indicative of sepsis are late findings. They include chills, fever, shock, delirium, and coma.
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| study_ing
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well i get confused btw the two options when encountered with a case on the unilateral eye..
i think cranial nerve palsies may occur in both. ophthalmoplegia, chemosis and pain on eye movement are common to both as well. Visiual disturbances i think are common too..
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| cbenitesch
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but I think we can differenciate ém according to the extension and both ayes compriomise I think cellulitis is unilateral.
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