Clinical Pathway for Child with Suspected Preseptal or Orbital Cellulitis

 
 
  • Antibiotic Recommendations
  • Consults
  • Complications requiring escalation of care
    • Sub-periosteal abscess
    • Orbital abscess
    • Cavernous sinus thrombosis
    • Subdural empyema, brain abscess
Team Assessment
 
 
 
 
 
 
 
 
No Orbital Signs
Unclear Orbital Signs
Clear Orbital Signs
 
 
 
 
Preseptal Cellulitis
Orbital Cellulitis
 
 
 
 
Discharge
Admit
 
 
 
 
Ophthalmology and ENT Attending to Review
Considerations for Surgical Management
 
 
 
 
 
 
Admit Inpatient
Admit OR for Surgical Drainage
 
 
Inpatient Care
Inpatient Care
 
 
 
 
Monitor Treatment Response
Monitor Treatment Response
More frequent exams as indicated, obtain images for Epic
Daily Ophthalmology exam
More frequent exams as indicated, obtain images for Epic
 
 
 
 
 
 
 
 
Adequate Treatment Response
Inadequate Treatment Response After 36 hrs
Adequate Treatment Response
Inadequate Treatment Response After 36 hrs
  • Improved clinical findings
  • Improving fever curve
  • Tolerating PO intake
  • No improvement in clinical findings
  • No improvement in fever curve
  • Improved clinical findings
  • Afebrile for 24 hrs
  • Tolerating PO intake
New or worsening orbital signs
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Discharge
Daily re-evaluation until
adequate improvement
Discharge
Daily re-evaluation until
adequate improvement
Follow-up Ophthalmology 24-72 hrs
Follow-up Ophthalmology 24-72 hrs