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All cases of suspected orbital cellulitis should be promptly hospitalized and
treated with IV antibiotics. Recent studies confirm that in the absence of acute
visual compromise or other signs of disease progression, even children with small
or moderate-sized abscesses deserve a trial of medical therapy before surgical
intervention. Empiric broad-spectrum antibiotic treatment should be directed
toward known common pathogens, including skin flora when local trauma is the
likely etiology, and upper respiratory flora in cases of presumed underlying sinus
disease. Appropriate empiric regimens should include coverage for S. aureus
(including MRSA if unwell or risk factors are present), streptococci, and gramnegative bacilli. Anaerobic coverage should be added for cases associated with
sinusitis, an odontogenic source, or proven or suspected intracranial extension.
The yield of blood cultures post Hib vaccine is very low, however blood cultures
should be considered before initiating IV antibiotic therapy. Percutaneous
aspiration from the area of cellulitis is not recommended. Other systemic cultures
(e.g., cerebrospinal fluid) may be indicated if signs of systemic toxicity or
findings of CNS disease are present. The patient should be reevaluated daily
looking for signs of improvement. Ophthalmic consultation and evaluation is
recommended for all pediatric patients with orbital cellulitis.
Otorhinolaryngology consultation should also be considered in those with
associated sinusitis. Neurosurgical consultation is needed for those with
intracranial extension.

Conjunctivitis
CLINICAL PEARLS AND PITFALLS
Not all cases of “red eye” are due to conjunctivitis.
Gonorrhea should be suspected in a neonate with purulent
conjunctivitis.
Antimicrobial therapy is not indicated for cases of viral conjunctivitis.
Contact lens wearers with conjunctivitis are at risk for keratitis and
should remove their contact lens and be evaluated by an
ophthalmologist.
Steroid drops should not be prescribed by the ED clinician.

Current Evidence
The conjunctiva is the mucous membrane that lines the inner surface of the
eyelids and reflects back to cover the surface of the globe up until the cornea.