This document discusses orbital complications that can arise from acute rhinosinusitis. It begins by providing epidemiological information and noting the decreased incidence of complications due to antibiotic use. It then classifies orbital complications according to Chandler's system and describes each type in more detail. Preseptal cellulitis and orbital cellulitis are the most common and involve inflammation outside or within the orbit respectively. Abscesses such as subperiosteal or orbital abscesses involve pus collections. Cavernous sinus thrombosis is a rare but serious intracranial complication. Evaluation involves history, exam, and CT imaging. Treatment depends on severity but generally involves IV antibiotics and possibly surgical drainage or decompression.

1. Sulaimanyia Teaching Hospital
ENT CENTER
ORBITAL COMPLICATIONS OF
ACUTE RHINOSINUSITIS
Presented by:- Dr . Sahar j .Hadi
ENT Center- Sulaimanyia Teaching Hospital- Sulaimanyia- Iraq

2. CONTENTS
Introduction
Epidemiology
Classification of orbital complications.
Pathogenesis.
Management.
 Medical And Surgical Treatment.

3. INTRODUCTION
Acute bacterial sinusitis occurs commonly,
usually as a sequel of an upper respiratory
infection. Spread of infection outside the
sinuses results in complicated sinusitis. The
incidence of complications from both acute
and chronic sinusitis has decreased four fold
due to the widespread use of antibiotics for
rhinosinusitis.

4. COMPLICATION
CHRONIC
DISTANTLOCAL
ACUTE

5. ANATOMICAL CONSIDRATIONS

7. Muscular and periorbita

8. RISK FACTORS
 Seasonal variations.
Gender: Male
 Age increase admission due to complication
(3-6 yeas).
Above 7years intracranial complication.
Adult intracranial complication due to CRS,
while intracranial complications in child due to
ABRS.
 Underdeveloped sinuses, highly vascular
valveless diploic system, immature posterior
table, arachnoid layer.

9. Pathogenesis
• Through the wall of sinusitisDirect
spread
• Through the subperosteal
venous plexus
Venous
spread
• Perivascular lymphatic spread
to subperiosteal plane
Lymphatic
spread

10. CLASSIFICATION: according to Chandlers 1970

12. 1-PRESEPTAL CELLULITIS
-complication of ethmoid sinusitis .
-Far most common in pediatric age group.
-Exclude the other causes
-medical comorbidities and immune
deficiencies are risk factors for preseptal
cellulitis.
-Manifests as eyelid swelling, erythema, and
tenderness.
-There are no limitation of extra ocular muscles
movements. and no impairment of visual
acuity.
- Due to impaired venous drainage of the
ethmoidal vessels that are obstructed by
inflammation and pressure.

13. ORBITAL CELLULITIS
Orbital cellulitis is a postseptal infection .
manifests as diffuse edema of the orbital contents
without a discrete abscess .
There is eyelid edema and erythema, proptosis, and
chemosis with limited or no impairment of
extraocular movements and normal visual acuity
early in the disease process.
Visual changes and ophthalmoplegia indicating
optic neuritis and/or ischemia can occur as the
disease progresses, these are prognostically
worrisome finding.

14. SUBPERIOSTEAL ABSCESS
 Collection of pus forms at the medial aspect of the
orbit between the periorbita and the lamina
papyracea .
 This is the second most common orbital
complication of sinusitis .
 Sever proptosis, ophthalmoplegia.
 A subperiosteal abscess can displace the orbital
contents and globe downward and laterally with
normal mobility in the early stages.
 An abscess may occasionally rupture the orbital
septum and present in the eyelids.

15. Orbital abscess
 An orbital abscess occurs when orbital cellulitis
coalesces into a discrete collection of pus
within the orbital tissues.
 This is a serious complication that can be
associated with severe exophthalmos and
chemosis, complete ophthalmoplegia and
visual impairment with a risk for progression to
irreversible blindness.
 On rare occasions there is spontaneous
drainage of purulent material through the
eyelid.

16. CAVERNOUS SINUS
THROMBOSIS
 can be considered an orbital as well as an
intracranial complication of sinusitis.
 Venous congestion in the orbit results in
bilateral orbital pain, chemosis, proptosis, and
ophthalmoplegia. Cranial nerves III, IV; Vl, V2,
V3, and VI traverse the sinus and can all be
affected.
 Extension of the phlebitis posteriorly into the
cavernous sinus results in progression of
symptoms in the opposite eye.
 It can be associated with sepsis and
meningismus or frank meningitis may be
present.

17. EVALUTIONS
 HISTORY(Symptoms of URTI + symptoms of ABRS).
 PHYSICAL EXAMINATION.(nasal cavity , orbital EX).
 RADIOLOGY.
Computed tomography (Ct) is considered the gold standard for
orbital complications of ABRS (axial + coronal view).
Aim:
1-To confirm the diagnosis.
2-Define the extent and site of disease.
3-give idea about the treatment modalities.
4-exclude other complications.

18. INDICATIONS:
1-In preseptal inflammation progress in 24-48hr
despite medical treatment.
2- suspected post septal complications.
3-exclude intracranial abscess.

21. TREATMENT: (all need admission , antibiotic)
>3 years oral
Borad
spectrum
antibiotic
+conservative
treatment
IV antibiotic
+- sinus
drainage
IV antibiotic
+sinus
drainage
+abscess
drainage
IV antibiotic
+- sinus
drainage
+- abscess
drainage

22. INDICATIONS OF SURGICAL
INTERVENTIONS

23. INDICATIONS OF MEDICAL TREATMENT
IN MEDIALSUBPERIOSTEAL ABSCESS
Abscess width<4mm

24. Surgical Treatment

25. Orbital Decompression
Indications Orbital
Cellulitis/Abscess
Retro Orbital
Hemorrhage
Graves Orbitopathy

26. Complications
Diplopia
Impair vision
Post.op/epistaxis
Post/op sinusitis

27. vedio

28. THANK YOU