Other ENT Emergencies
Mr T Rockley (consultant ENT surgeon) and Dr A McLeod


Acute orbital cellulitis

This condition is usually secondary to sinusitis. It's main differential is the less dangerous (but often more visually severe-looking) pre-septal cellulitis.


Clinical signs can include:

In both preseptal cellulitis and orbital cellulitis
  • Fever / headache
  • Eyelid oedema
  • Pain
  • Red eye
  • Unwell-looking

Orbital cellulitis often has:
  • Decreased eye movement
  • Decreased vision
  • Papilloedema
  • Proptosis
 Orbital Cellulitis
Orbital Cellulitis

Management:

Acute facial paralysis (Bell's palsy)

Facial palsy is only called Bell's if it is idiopathic: exclude ear and parotid disease. A Bell's palsy is actually a post-herpetic autoimmune neuritis of the facial nerve. Most cases recover completely. If there are vesicles visible in the ear canal, this is a more severe form of the disease (Ramsey-Hunt syndrome) and carries a worse prognosis for recovery.

You can describe the effect of the palsy by using the House-Brackman scoring system.

Management:
Prescribe a short course of steroids eg prednisolone 20 mg tds x five days, provided there is no contraindication to this eg diabetes. Also prescribe a course of oral acyclovir (200 mg 5x daily for 5 days) if within the first three days or if a severe palsy. Arrange followup in ENT clinic over the next few days.

Eye protection
Be aware that if the eye can't close properly as a result of the facial paralysis, the patient is at risk of exposure keratitis, corneal abrasion, or corneal ulcer. These are avoidable causes of blindness. Ask the patient to put artificial tears in their eye during the day, and tape the upper eyelid down to shut the eye at night . Explain to them that if they experience visual loss, or if the eye becomes red or painful, they must reattend and see the Eye emergency doctor the same day.



PATHOLOGYPHARMACOLOGYMAIN PAGELINKSiBSc

Updated 23/08/09