眼科 / 耳鼻咽喉 / 小児
眼窩蜂窩織炎（中隔後） — パス
眼球運動時痛+突出+外眼筋麻痺は中隔後を示唆。入院+造影CT+抗菌。
根拠：StatPearls / Merck。各ノードはガイドラインの判断ロジックを要約したものであり、原文の転載ではありません。 医療従事者向けの参考情報であり、臨床判断の代替ではありません。日本の関連学会指針および施設プロトコルを優先してください。
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ステップ 1 · Preseptal vs postseptal
Preseptal vs postseptal? (pain on eye movement/proptosis/ophthalmoplegia)
💡 Infection of postseptal soft tissue (muscle/fat) (vs preseptal = eyelid only); more common in children, 86–98% from sinusitis (ethmoid), also odontogenic/traumatic. Key distinguishing features: pain on eye movement + proptosis + ophthalmoplegia + chemosis ± reduced vision/RAPD + fever and raised WBC (eyelid swelling occurs in both and does not differentiate); bilateral → suspect cavernous sinus thrombosis. Complications: vision loss (~11%)/subperiosteal or orbital abscess/cavernous sinus thrombosis/meningitis/brain abscess.
パス全体像
- 【判断】Preseptal vs postseptalPreseptal vs postseptal? (pain on eye movement/proptosis/ophthalmoplegia)（Infection of postseptal soft tissue (muscle/fat) (vs preseptal = eyelid only); more common in children, 86–98% from sinusitis (ethmoid), also odontogenic/traumatic. Key distinguishing features: pain on eye movement + proptosis + ophthalmoplegia + chemosis ± reduced vision/RAPD + fever and raised WBC (eyelid swelling occurs in both and does not differentiate); bilateral → suspect cavernous sinus thrombosis. Complications: vision loss (~11%)/subperiosteal or orbital abscess/cavernous sinus thrombosis/meningitis/brain abscess.）
- Postseptal (pain on movement/proptosis/ophthalmoplegia/reduced vision) → Postseptal → admit + IV antibiotics
- Preseptal (eyelid swelling only, none of the above) → Preseptal · oral antibiotics + follow-up
- 【終点】Preseptal · oral antibiotics + follow-up眼窩蜂窩織炎（中隔後） — パスの当該分岐。適応・禁忌を確認し、最新ガイドラインと施設プロトコルに沿って実施。必要時専門医に相談。
- 【終点】Postseptal → admit + IV antibioticsPostseptal (orbital cellulitis): 入院 + contrast CTのorbits + sinuses (lookに対しsubperiosteal/orbital abscess・source) + IV broad-spectrum 抗菌薬 (cover MRSA + Strep + anaerobes, 例: vancomycin + ceftriaxone/ampicillin-sulbactam ± metronidazole) + ophthalmology/ENT consult; nasal decongestants/irrigation; surgical ドレナージ — orbital abscess/largeまたはnon-resolving subperiosteal abscess/visual deterioration/no improvement on 抗菌薬 at 24–48 h/intracranial complications; orbital compartment syndrome (acute visual threat, raised IOP, proptosis) → emergency lateral canthotomy.
よくある質問
- 眼窩蜂窩織炎（中隔後） — パスはどの臨床課題を扱う診療パスですか？
- 眼球運動時痛+突出+外眼筋麻痺は中隔後を示唆。入院+造影CT+抗菌。
- 眼窩蜂窩織炎（中隔後） — パスの主要な意思決定ステップは何ですか？
- Preseptal vs postseptal
- 眼窩蜂窩織炎（中隔後） — パスはどのような対応方針を示しますか？
- Preseptal · oral antibiotics + follow-up：眼窩蜂窩織炎（中隔後） — パスの当該分岐。適応・禁忌を確認し、最新ガイドラインと施設プロトコルに沿って実施。必要時専門医に相談。；Postseptal → admit + IV antibiotics：Postseptal (orbital cellulitis): 入院 + contrast CTのorbits + sinuses (lookに対しsubperiosteal/orbital abscess・source) + IV broad-spectrum 抗菌薬 (cover MRSA + Strep + anaerobes, 例: vancomycin + ceftriaxone/ampicillin-sulbactam ± metronidazole) + ophthalmology/ENT consult; nasal decongestants/irrigation; surgical ドレナージ — orbital abscess/largeまたはnon-resolving subperiosteal abscess/visual deterioration/no improvement on 抗菌薬 at 24–48 h/intracranial complications; orbital compartment syndrome (acute visual threat, raised IOP, proptosis) → emergency lateral cantho…
- 眼窩蜂窩織炎（中隔後） — パスのうち直ちに対応が必要な状況はどれですか？
- Postseptal → admit + IV antibiotics：Postseptal (orbital cellulitis): 入院 + contrast CTのorbits + sinuses (lookに対しsubperiosteal/orbital abscess・source) + IV broad-spectrum 抗菌薬 (cover MRSA + Strep + anaerobes, 例: vancomycin + ceftriaxone/ampicillin-sulbactam ± metronidazole) + ophthalmology/ENT consult; nasal decongestants/irrigation; surgical ドレナージ — orbital abscess/largeまたはnon-resolving subperiosteal abscess/visual deterioration/no improvement on 抗菌薬 at 24–48 h/intracranial complications; orbital compartment syndrome (acute visual threat, raised IOP, proptosis) → emergency lateral canthotomy.
- 眼窩蜂窩織炎（中隔後） — パスはどのガイドラインに基づいていますか？
- Orbital cellulitis (StatPearls; Merck Manual; EyeWiki) · 準拠：StatPearls / Merck
出典
- Orbital cellulitis (StatPearls; Merck Manual; EyeWiki)