A Case Study on Orbital cellulitis .pptx

Contains a Detailed case study on Orbital Cellulitis

1. A Case Presentation on Orbital Cellulitis Presented by P J Hemanth Reddy 19Y01T0018 Pharm.D VIth year CESCOP

2. Orbital cellulitis Orbital cellulitis is an infection of the soft tissues of the eye socket behind the orbital septum, a thin tissue which divides the eyelid from the eye socket. Orbital cellulitis most commonly refers to an acute spread of infection into the eye socket from either extension from periorbital structures (most commonly the adjacent ethmoid or frontal sinuses (90%), skin, dacryocystitis , dental infection, intracranial infection), exogenous causes (trauma, foreign bodies, post-surgical), intraorbital infection ( endophthalmitis , dacryoadenitis ), or from spread through the blood (bacteremia with septic emboli).

3. Orbital cellulitis may occur at all age groups but is more commonly seen in children. The incidence in children is 1.6 per 100,000 compared to adults 0.1 per 100,000. Gender distribution is usually equal; however, the males predominate in some countries because of work-related injuries as in India and Nigeria. Orbital cellulitis has its peak incidence in winter and early spring and is least frequent (19.4%) in the summer months Epidemiology Etiology Orbital cellulitis occurs in the following three situations Extension of an infection from the paranasal sinuses or other periorbital structures such as the face, globe, or lacrimal sac Direct inoculation of the orbit from trauma or surgery Hematogenous spread from bacteremia Streptococcus species and Staphylococcus aureus are the most common types of bacteria that cause orbital cellulitis. However, other bacterial strains and fungi can also be the cause of this condition.

4. PATHOPHYSIOLOGY Immediately the immune cells will detect the bacteria and try to kill it by releasing inflammatory cytokines → Release of Cytokines cause VASODILATION, increased VASCULAR PERMEABILITY and increased recruitment attack of immune cells Neutrophils circulating in the blood vessels will enter into the tissue area of invasion due to increased Vascular Permeability → Neutrophils and other immune cells eat up and try to kill the bacteria The interaction between neutrophils and bacteria leads to the formation of an abscess or pus. Pus consists of dead leukocytes, dead skin cells, and bacteria When it bursts it causes Edema and other symptoms → CELLULITIS

5. Clinical presentations: ptosis pain in or around the eye nasal tenderness swelling of the eye area inflammation and redness inability to open the eye trouble moving the eye and pain upon movement of the eye double vision vision loss or impaired vision discharge from the eye or nose fever headache

6. Diagnosis: Physical examination CT scan MRI Brain Complete blood picture Standard treatment: Cap. Amoxicillin 500 mg + Cloxacillin 500mg - 3 divided doses for 7 to 10 days Inj. Gentamicin 5mg/kg - 2 divided doses for 7 days Inj metronidazole 500mg Oxymetazoline 0.05% nasal drops in each nostril 2 times a day Eye drops Gatifloxacin 3mg, 3 times a day

7. A 4 8 years old male patient was admitted in male medical ward with IP No: 8865 under the consultant doctor Dr. M.Abdul Hussain M.D, with chief complaints of Fever c̅ Headache ∵ 15 days, complete ptosis c̅ blurred vision to the right eye ∵ 10 days, swelling of right eye ∵ 10 days. And he also a k/c/o Hypertension ∵ 7 years, on unknown medication. The personal History & Habits shows Mixed diet , Normal Sleep , Normal appetite , not an Alcoholic & Smoker , and with Regular Bowel & Bladder habits with no significant Family history . SOAP NOTES DEMOGRAPHIC DATA SUBJECTIVE EVIDENCE Patient name: xxxxxx Gender: M ale Age: 48 years IP.no: 8865 DOA: 4/01/2025 Department: MM-VI Consultant Doctor: Dr.M.Abdul Hussain M.D

8. SOAP NOTES OBJECTIVE EVIDENCE C BP WBC 13,100 cells/µL RBC 4.5 cells/µL HB 13.2 gm/d L PLT 2.56 plt / µL Serum Electrolytes Na+ 133 mmol/L K+ 4.2 mmol/L Cl- 104 mmol/L Liver function test Total.Br 0.5 mg/dl Direct.Br 0.2 mg/dl SGPT 21 U/L SGOT 19 U/L ALP 156 IU/Lit T.proteins 6.4 gm/dl Sr.Albumin 5.3 gm/dl MRI IMP: Isointense lesions in Rt cavernous sinus / sphenoid wing Rt orbital apex & along with Rt optic nerve Orbital cellulitis with cavernous extension Renal function test Blood Urea 26 mg/dl Sr Creatinine 0.8 mg/dl PLANNING Based on the subjective and objective evidence the patient was already a known case of Hypertension and newly diagnosed with Orbital cellulitis.

9. PLANNING S.No Brand name Generic name Indication Dose ROA Frequency Duration 1 Ceftriaxone Ceftriaxone Antibiotic 1 gm IV BD D1-Till date 2 Pantop Pantoprazole PPI 40mg IV OD D1-Till date 3 Shelcal Calcium + Vitamin- D3 Nutritive agent 500mg 250 IU PO OD D1-Till date 4 B-complex Vitamin-B Nutritive agent PO OD D1-Till date 5 Gatikind Gatifloxacin Antibiotic 3mg Ophthalmic TID D1-Till date 6 Lacryl Hypromellose Lubricating agent 0.3% w/v Ophthalmic BD D1-Till date 7 Clindamycin Clindamycin Antibiotic 600mg IV BD D1-Till date 8 Telma Telmisartan Antihypertensive 40mg PO OD D1-Till date 9 PCT Paracetamol Antipyretic 500mg PO TID D1-Till date

10. PROGRESS CHART Prognosis Treatment Day-1 [0 4 / 01 /2 5 ] O/E Pt-C/C Temp - Febrile PR -78 bpm BP - 140/90 mmHg Spo2 -97% c̅ RA CVS -S1S2 + RS -B/L BAE + P/ A - Soft 🔺 Orbital Cellulitis c̅ Hypertension Rx Inj. Cefotaxime 1 gm IV BD Inj. Pantop 40 mg IV OD Tab. B-complex PO OD Tab. Shelcal PO OD Lacry 0.3% w/v ophthalmic BD Gatikind 3 mg ophthalmic TID Inj. Clindamycin 600mg IV BD Tab. Telma 40 mg PO OD Tab. PCT 500 mg PO TID Day-2 [05/01/25] O/E Pt-C/C Temp -Febrile PR - 83 bpm Rx CST

11. PROGRESS CHART BP - 140/80 mmHg Spo2 -97% c̅ RA CVS -S1S2 + RS -B/L BAE + P/A -Soft CNS- NoFND Day-3 [06/01/25] ℅ ↓ed fever O/E Pt-C/C Temp -Afebrile PR - 98 bpm BP - 130/80 mmHg Spo2 -98% c̅ RA CVS -S1S2 + RS -B/L BAE + P/A -Soft CNS- NoFND Rx CST

12. MECHANISM OF ACTION Mechanism of Action ADRs MP Ceftriaxone : It exhibit bactericidal effect by inhibiting the cell wall synthesis of bacteria by inhibiting the enzyme called transpeptidases Nausea Vomiting Abdominal pain CBP and signs of allergic reaction Pantoprazole: It binds to H+/K+ ATPase Pump and thereby inhibiting gastric acid and basal acid secretion. Headache Stomach pain Monitor GI symptoms Hypromellose: Enhances moistening of the cornea and conjunctiva and allows for a smoother movement of the conjunctiva over the cornea Headache, pain in eye, raise intraocular pressure intraocular pressure Gatifloxacin: Gatifloxacin inhibits bacterial DNA topoisomerases required for bacterial DNA replication, transcription, repair and recombination of DNA. Taste sense altered, exacerbation, excessive tear production. Improvement in signs and symptoms of bacterial conjunctivitis Clindamycin: Clindamycin inhibits bacterial protein synthesis by binding to 23s RNA of the 50s subunit of the ribosomes. Dry skin, Diarrhoea, Nausea. monitor for diarrhea, nausea

13. MECHANISM OF ACTION Mechanism of Action ADRs MP Telmisartan: Telmisartan is an angiotensin II receptor blocker (ARB) that selectively blocks AT₁ receptors , leading to vasodilation, reduced aldosterone secretion, and lower blood pressure . cough, upper respiratory tract infection Blood pressure Paracetamol: Paracetamol works by inhibiting prostaglandin synthesis, primarily in the central nervous system, exerting its analgesic and antipyretic effects. Stomach pain Nausea Vomiting Fever Pain

14. PHARMACIST INTERVENTION PATIENT COUNSELING REGARDING DISEASES Orbital cellulitis is an infection of soft tissue and fat that hold the eye in the socket. RATIONALITY DRUG INTERACTIONS The given treatment was found to be Rational No drug - drug Interactions found REGARDING DRUGS Tab B-complex Should be taken Orally, once a day as a vitamin supplements. Tab Shelcal Should be taken Orally, once a day as a calcium & vitamin-C supplements. Tab. Telmisartan 40 mg should be taken once a day to treat hypertension. Tab. Paracetamol 500 mg should be taken thrice a day to treat fever.

15. Do not scratch bug bites or areas of injury. Do not share personal items, such as towels, clothings. Wear protective equipment when you are in work. Should not rub infected eyes. Do not swim until the infection cured Use doctor prescribed eye drops and don't miss daily doses. Cover the infected eye with a dried cloth or spectacles while going outside. PATIENT COUNSELING LIFESTYLE MODIFICATIONS REFERENCES https://www.healthline.com/health/orbital-cellulitis https://www.kenhub.com/en/library/anatomy/the-cavernous-sinus https://emedicine.medscape.com/article/1217858-overview https://eyewiki.org/Orbital_Cellulitis

16. Thank you P J Hemanth Reddy