Orbital cellulitis, among ocular emergencies that need immediate intervention to prevent fal complications.

1. Orbital cellulitis
OPHTALMOLOGY DEPARTMENT, CHUK
BY NIYOMUGABO Clisson, DOC II
09th/04/2022

2. Outline
 Introduction
 Clinical presentation
 Etiology
 Management
 complications

3. Introduction
 Orbital cellulitis is infection of tissues (orbital fats and extraocular
muscles) behind the orbital septum.
 The orbital septum is the major anatomical landmark separating
anterior part(eyelids) from posterior part (orbit)
 Infection to tissues anterior to orbital septum is known preseptal
cellulitis and infection to tissues posterior to it is known as orbital
cellulitis
 Life threatening, Serious orbit infection, Most commonly caused by :
S. pneumonia, S. aureus, S. pyogenes and H. influenza.
 Highly associated with sinusal Infection especially ethmoid sinus
infection.
 More commonly seen in children . Incidence 1.6 per 100,000
compared to adults 0.1 per 100,000.

4. Clinical presentation
 Proptosis
 ophthalomoplegia
 Edema
 Pain
 Afferent pupillary defect
 Proptosis
 Optic nerve swelling
Other symptoms: fever, headache, malaise, rhinorrhea.

5. Pathogenesis
 Occurs in 3 ways:
 Extension of an infection from the paranasal sinuses or other periorbital structures
such as the face, lacrimal sac, or globe.
 Ethymoid sinus account for 90% of all cases.
 direct inoculation of the orbit from trauma or surgery (orbital decompression).
 Hematogenous spread from bacteremia

6. investigations
 Labs:
 CBC
 ESR, CRP
 Urea and creatinine
 Blood cultures
 Imaging:
 CT scan with contrast for better visualization of soft tissues
 MRI if available is a better option
 US to rule out orbital myositis

7. Management
 Patient with orbital cellulitis should be hospitalized for treatment until the patient is
afebrile and improved clinically.
 Medication: broad spectrum iv antibiotics until culture results.
 IV Atbs for 2 weeks, then oral Atbs for 2-3 weeks.
 Fungal infection require iv antifungal therapy along with surgical debridement.
 Surgery:
 Canthotomy and cantholysis if compartment syndrome is diagnosed.
 Surgical drainage if:
 Decrease in vision
 Proptosis progresses
 Size of abscess not decrease on CT Scan after 48 hrs.

8. complications
 Orbital abcess
 Subperiosteal abcess
 Cavernous sinus thrombosis
 Optic neuropathy
 Raised IOP
 Occlusion of central retinal artery
 Parotid/temporal abcess
 Meningitis
 Brain abcess
 Septicemia

9. Thank you