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Similar to orbital cellulitis
orbital cellulitis
- 1.
- 2. Acute infectionof the soft tissues of the orbit behind the orbital septum May/may not progress to a subperiosteal/orbital abscess
- 3. Etiology Modes of infection Exogenous infection Result from penetrating injury Extension of infection from neighbouring structures Paranasal sinuses, teeth, face, lids, intracranial cavity, intraorbital structures Endogenous infection Rarely develop as metastatic infection from breast abscess,etc. Causative organisms Streptococcus pneumoniae Staphylococcus aureus Streptococcus pyogenes Haemophilus influenzae
- 4. Pathology Similar tosuppurative inflammations of the body in general except: • d/t absence of lymphatics in the orbit Infection establishes early • Infections spreads as thrombophebitis from surrounding structures Rapid spread with extensive necrosis • As orbital infection is ass. With raised intraorbital pressure d/t tight compartment Damage produced is rapid and extensive
- 5. CLINICAL FEATURES Symptoms Swelling and severe pain (increased by movements of eyeball/pressure) Ass. General symptoms- fever, nausea, vomiting & prostrations Visual loss &/ diplopia in moderate to advanced disease
- 6. Signs Swellingof lids (woody hardness & redness) Chemosis of conjunctiva (protrude & become desiccated/necrotic) Axial proptosis Restriction of ocular movements (mild-severe) RAPD –complications in the form of optic neuropathy/CRAO Fundus examination –congestion of retinal veins, papillitis/papilloedema)
- 7. COMPLICATIONS Ocular complications * Exposurekeratopathy * Optic neuritis * CRAO Orbital complications * Subperiosteal abscess * Orbital abscess Temporal/parotid abscess *d/t spread of infection around the orbit Intracranial complications * Carvenous sinus thrombosis * Meningitis * Brain abscess General septicemia/pyaemia
- 8. • Collection ofpurulent material between the orbit bony wall & periosteum • Suspected when associated with eccenteric proptosis • Confirm by CT scan Subperiosteal abscess • Collection of pus within orbital tissue • Suspected by signs of severe proptosis, marked chemosis, complete ophthalmoplegia & pus point below conjunctiva • Confirm by CT scan Orbital abscess
- 9. INVESTIGATIONS Bacterial cultures From nasal and conjunctival swabs and blood samples Complete haemogram May reveal leukocytosis X-ray PNS Identify associated sinusitis Orbital ultrasonography Detect intraorbital abscess CT scan & MRI Differentiating preseptal & postseptal cellulitis Detect subperiosteal abscess Orbital abscess Intracranial extension Deciding when & where to drain orbital abscess
- 10. TREATMENT Orbital cellulitisis an emergency! Hospitalised the patient for aggressive management 1. Intensive antibiotic therapy • Staph infections: high doses of penicillinase-resistant antibiotics+ampicillin • Alternative: cefotaxime, ciprofloxacin, vancomycin • H. influenzae : chloramphenicol / clavulanic acid • Anaerobes : oral metronidazole 500mg every 8 hours 2. Analgesic & anti-inflammatory drugs • control pain and fever 3. Topical antibiotic eye ointment • QID, for corneal exposure and chemosis (severe proptosis) 4. Start nasal decongestant drops 5. Revaluation • 2-3 times/day • to monitor the response and modify the Rx accordingly
- 11. Surgical intervention Indications: Unresponsiveness to antibiotics Decrease vision Presence of an orbital/subperiosteal abscess Immediate canthotomy / cantholysis If the orbit is tight, presence of optic neuropathy, IOP severely elevated. Free incision into the abscess When presence under skin or conjunctiva. Drainage of pus For subperiosteal abscess : 2-3 cm curved incision in upper medial aspect. Drain both orbit and infected paranasal sinuses.