Orbital Complications Of Acute Rhinosinusitis

1. 8 yearsold girl medically free
CC: Lt.eye swelling X4days
URTI6 days prior presentation
odynophagia , fever , rhinorrhea and cough
Headache
Not startedon antibiotics
Lt.eye swelling  4 days prior presentation
seenin eyespecialist hospital CTsinusesdone
and referred toENT.
LAMAasno more fever and headache
Admitted 2ndday.

2. Vitallystable , afebrile
Conscious oriented , not on pain or distress
Nose: congestedmucosa, no purulent
discharge ,patent
Throat : not congested, no PND
Ears: intactTM B/L
Eyes: Lt.eye swelling and erythema .
Can’t open her eyesbczpain.
Tenseon palpation
vision and EOM intact

3. Admission
Ophthalmology consultation
Blood inv.
CTsinuses
IVAntibiotics
plan for surgery asnot improved

16. Left lateral orbit collection (2 x1.2x0.6 cm) with masseffect
on the left globe manifested by medial rotation of the globe.
Peripheral enhancement post IVcontrast suggests orbital
Abscess.
Orbital cellulitis.
The left maxillary sinus shows opacification witharelatively
central hyperdensity suggestive of early pyogenic sinusitis.
the left anterior ethmoid and left frontal sinusesshow
complete opacification.
Lacrimal gland is diffusely enlarged suggestiveof
inflammation.
Conclusion:left orbital cellulitis with left lacrimal gland
involvement possibly due to adjacent sinus disease with
preseptal and supraorbitalabscess.

17. Ophtha : I&D on most prominent area and packing
with povidonegauze
Lt. FESSdone:
 Findings : severly inflammed nasalmucosaand turbinates
with DNStoLt.
large adenoid obstructing75%choana
 M.Tmedialization , widening maxillary osteum and
cleaning maxillary sinus withirrigation.
 Bulla ethmoidalis removed reaching ant.ethmoids cleaned
and irrigation wasfull of pus
 Frontal sinus osteum identified&cleaned with irrigation
with saline
 Pack inserted in middlemeatus

19. Results from athrombophlebitis and
interference with the venousdrainage of the
orbital contents.
superior and inferior ophthalmic veins are
valveless, allowing direct communication
between the nose,ethmoid sinuses,face, orbit,
and cavernoussinus
congenital or other dehiscences in the lamina
papyraceaexposethe orbital contents to direct
extension of sinusitis

20. Orbital periosteum is important structure
because it is the only soft tissue barrier
between the sinusesand the orbital contents.

27. CTevidence of abscessformation
20/60 or worse visual acuity is observedon
initial evaluation
progression of orbital signs andsymptoms
occurs despite medicaltreatment
or lack of improvement is seenwithin 48
hours despite aggressivemedical treatment

28. Auseful framework for assessingpatients outlined by
Oxford and McClay:
medial subperiosteal abscesswith normal vision
(better than20/40)
No ophthalmoplegia,
intraocular pressurelessthan 20mm Hg,
proptosis less than5mm,
and width of abscesslessthan 4 mm onCT
canbe consideredfor possible medical management.
Theseobjective criteria were shown retrospectively to
predict successful medical management with good
outcomes, evenin older children.