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Orbital pseudotumor
From WikEM
Contents
Background
- Also known as idiopathic orbital inflammation
- Swelling of any area of the orbit
- Diagnosis of exclusion
- Chronic condition characterized by orbital sclerosis and relapses[1]
Clinical Features
- Proptosis[2]
- Chemosis
- Cranial nerve palsy
- Diplopia
- Pain
Differential Diagnosis
Periorbital swelling
Proptosis
- Normal IOP
- Orbital cellulitis
- Orbital pseudotumor
- Orbital tumor
- Increased IOP
- Retrobulbar abscess
- Retrobulbar emphysema
- Retrobulbar hemorrhage
- Orbital tumor
No proptosis
- Periorbital cellulitis/erysipelas
- Dacryocystitis (lacrimal duct)
- Dacryocele/Dacryocystocele
- Dacryostenosis
- Dacryoadenitis (lacrimal gland)
- Allergic reaction
- Nephrotic Syndrome (pediatrics)
Lid Complications
- Blepharitis (crusts)
- Chalazion (meibomian gland)
- Stye (hordeolum) (eyelash folicle)
Other
- Subperiosteal abscess
- Orbital abscess
- Cavernous sinus thrombosis
- Conjunctivitis
- Contact dermatitis
- Herpes zoster
- Herpes simplex
- Sarcoidosis
- Granulomatosis with polyangiitis
Evaluation
- CT Orbit with IV contrast
- Evaluate for tumor vs infectious etiology
- Imaging findings may be similar to orbital cellulitis
- MRI orbit gold standard
Management
Vancomycin 15-20mg/kg IV BID + (one of the following)
- Ampicillin/Sulbactam 3 g IV q6hr OR
- Ticarcillin/Clavulanate 3.1 g IV q4h OR
- Piperacillin-Tazobactam 4.5 g IV q6h OR
- Ceftriaxone 2 g IV q12hr OR
- Cefotaxime 2 g IV q4h
- Dramatic improvement with steroids in 24-28 hours (in consultation with ophthalmology)
Consults
- Ophthalmology
Disposition
- Discharge with close ophthalmology followup
Complications
- Vision loss
- Oculomotor dysfunction
References
- ↑ Rubin, P. A. D. and Foster, S. C. (2004) ‘Etiology and management of idiopathic orbital inflammation’, American Journal of Ophthalmology, 138(6), pp. 1041–1043.
- ↑ Yuen, S. A. J. (2003) ‘Idiopathic Orbital Inflammation’, Archives of Ophthalmology, 121(4).
Authors
Kian Preston-Suni, Tianjiang Ye, Neil Young, Daniel Ostermayer
