2. ORBITAL SEPTUM
The orbit is separated from the
soft tissue of the eyelid by the
orbital septum.
This is a fascial plane that is
continuous with the periosteum of
the facial bones.
Orbital septum inserts into the
tarsal plate of the upper and lower
eyelids.
It proves to be an effective barrier
that prevents the spread of
infection from the eyelids
posteriorly to the orbit
3. PRESEPTAL CELLULITUS
Infection of the subcutaneous tissues anterior to the
orbital septum
Aetiology : staphylococcus aureus , streptococcus ,
hemophillius influenza
Mode of infection :
Exogenous : following skin laceration , insect bites
and eyelid operations
Endogenous : hematogenous spread from remote
infection of the middle ear or URT
Extension from local infection : from an acute
hordeolum or acute dacryocystitis
4. PRESEPTAL CELLULITIS
C/F:
Inflammatory edema of the eyelids and periorbital skin with
no involvement of the orbit
painful periorbital swelling
Erythema and hyperemia of the lids
Fever
Proptosis is absent
Ocular movements are normal
Normal visual acuity and conjunctiva
5. TREATMENT
Systemic antibiotics
Mild to moderate cases : amoxiclav 500/125vmg tds
Sever cases : hospitalization , iv ceftriaxone (1-2
g/day in divided doses for 4-5 days )
Systemic analgesic and anti inflammatory to reduce
pain and swelling
Warm compression 2-3 times a day
Surgical exploration and debridement required in
presence of an abscess
7. ORBITAL CELLULITUS
Refers to an acute infection of the soft tissues of
the orbit behind the orbital septum
Orbital cellulitis may or may not progress to a
subperiosteal abscess or orbital abscess
Causative organisms : Those commonly involved
are: Streptococcus pneumoniae, Staphylococcus
aureus, Streptococcus pyogenes and Haemophilus
influenzae.
8. ETIOLOGY
EXOGENOUS: penetrating injury associated with
retention of intraorbital foreign body , post operatively
evisceration
EXTENSION OF INFECTION FROM NEIGHBOURING
structures : paranasal sinuses, teeth, face, lids,
intracranial cavity and intraorbital structures.
It is the commonest mode of orbital infections.
ENDOGENOUS INFECTION. : metastatic infection
from breast abscess, puerperal sepsis, thrombophlebitis
of legs and septicaemia.
9. PATHOLOGY
:■Infection establishes early due to absence of
lymphatics in the orbit.
■Rapid spread with extensive necrosis is common
since in most cases infection spreads as
thrombophebitis from the surrounding structures.
■Damage produced is rapid and extensive as orbital
infection is associated with raised intraorbital
pressure due to the tight compartment.
10. SYMPTOMS :
Swelling and severe pain (which is increased by
movements of the eyeball or pressure)
Associated with fever, nausea, vomiting and
prostrations.
Vision loss and/or diplopia with moderate to
advanced disease
11. SIGNS
Swelling of lids, characterised by WOODY
HARDNESS AND REDNESS.
Chemosis of conjunctiva.
Axial proptosis
Restriction of ocular movements
RAPD may occur due to complications in the form
of optic neuropathy or central retinal artery
occlusion.
Fundus examination may show congestion of
retinal veins and signs of papillitis or papilloedema.
13. COMPLICATIONS
Cavernous sinus thrombosis
Orbital abscess:
collection of pus within the orbital soft tissue.
Clinically, it is suspected by signs of severe proptosis, marked chemosis, complete
ophthalmoplegia, and pus points below the conjunctiva, but is confirmed by CT scan
Sub-periosteal abscess:
collection of purulent material between the orbital bony wall and periosteum, most
frequently located along the medial orbital wall.
Clinically, subperiosteal abscess is suspected when clinical features of orbital cellulitis
are associated with eccentric proptosis; but the diagnosis is confirmed by CT scan.
Meningitis
Brain abscess
Septicemia, pyaemia
Optic neuritis & atrophy
C.R.A.O
Corneal ulceration
16. TREATMENT
I/V ANTIBIOTIC-gram positive coverage by
penicillinase resistant antibiotic,clauvalinic
acid,vancomycin
Analgesic & anti-inflammatory
Surgical intervention :
1. Unresponsiveness to antibiotic
2. Decreased vision
3. Orbital or subperiosteal abscess
17.
18. VENOUS SINUSES
The dural venous sinuses (also
called dural sinuses, cerebral
sinuses, or cranial sinuses)
are venous channels found between
the endosteal and meningeal layers
of dura mater in the brain.
They receive blood from internal and
external veins of the brain,
receive cerebrospinal fluid (CSF)
from the subarachnoid
space via arachnoid granulations,
and mainly empty into the internal
jugular vein.
19. CAVERNOUS SINUS THROMBOSIS
Septic thrombosis of cavernous sinus sec. to sepsis along it’s
tributaries
COMMUNICATIONS
1. Ant.- sup. and inf. Ophthalmic v.
2. Post.-sup. and inf. petrosal sinus
3. Sup.- veins of cerebrum
4. Inf. - pterygoid plexus
5. Med.- intercommunicate by
transverse sinus
20.
21.
22.
23.
24. CLINICAL PICTURE
U/L initially then becomes B/L in 50%
Clinical features include high grade fever,rigors,
vomiting and headache
Ocular features
1.severe pain & headache
2.conj. Chemosis & cong.
3.rapid proptosis
4.3, 4, 6th cranial n. palsy
5. edema in mastoid region
6.papilledema & cong. of ret. V.
26. TREATMENT
I/V antibiotic in massive doses
Analgesics & antiinflammatory
I/V Amphotericin B in fungal inf.
Corneal protection
Surgical drainage of abscess
Treat underlying cause
27. Clinical fx ORBITAL
CELLULITIS
CAVERNOUS
SINUS
THROMBOSIS
PANOPHTALMIT
IS
LATERALITY U/L U/L EARLY
B/L LATE
U/L
PROPTOSIS MARKED MODERATE MODERATE
CORNEA &
A.C
CLEAR CLEAR HAZY,
HYPOPYON
OCULAR
MOVEMENT
PAINFUL,
LIMITED
COMPLETE
LIMITATION
PAINFUL
LIMITED
MASTOID EDEMA ABSENT PRESENT ABSENT
SYSTEMIC
FEATURES
MARKED MILD MILD
PROGNOSIS MODERATE GRAVE POOR
28. FACIAL TRAUMA AND FRACTURES
Midfacial fractures
ZMC fracture
Wall and floor fractures
medial wall- lamina papyracea
orbital floor- blow out vs rim involvement
lateral wall and orbital roof- less common
Optic canal fractures
traumatic optic neuropathy
