orbital inflammation

1. ORBITAL INFLAMMATION
DR.JEENA RAJ
DEPT. OF PATHOLOGYL

2. ■Pre-Septal cellulitis
■Orbital cellulitis
■Cavernous sinus
Thrombosis

3. ■ A] preseptal cellulitis B] orbital cellulitis
C] subperiosteal abscess D] orbital abscess
E] cavernous sinus thrombosis

4. 1. Preseptal cellulitis :– inflammation
involves structures anterior to the
orbital septum.
2. Orbital cellulitis: the inflammation
is behind the orbital septum which
may or may not spill over the lids

6. Preseptal cellulitis
Symptoms & signs:
❖ Swelling, erythema,
chemosis of lids
❖ Conjuntival discharge
❖ No proptosis, ocular
movements
❖ Vision not affected
Treatment:
❖ Antibiotics, NSAID

7. Orbital cellulitis
Def: Purulent inflammation of the cellular tissue
of the orbit.
Cause:
-Spread of inflammation from neighboring parts –
nasal sinuses, Dacryocystitis, dental infection,
deep injuries, retained foreign body,
-septic operations, DCR, RD, SQUINT
-posterior extension of suppurative infection of eye
lid, panophthalmitis, facial erysipelas,
- Metastases in pyaemia

8. Causative organisms
Streptococcus pneumoniae.
Staphylococcus aureus
Streptococcus pyogenes
Haemophilus influenzae. (children below 5 years)

9. Clinical features
1. Swelling, erythema, warmth, pain, tendernes of
the lid
2. Orbital abscess pointing on the skin or
conjunctiva

10. 3. Proptosis – lateral
and down
4. Restriction and pain
of ocular movements
5. Diplopia
6. Afferent pupillary
defect
7. Diminished vision
due to compression
of optic nerve, its
blood supply, optic
neuritis

11. Complications
1. Periorbital abscess
2. Exposure keratopathy
3. C.R.A and C.R.V occlusion
4. Panophthalmitis
5. Intracranial complications
- meningitis, brain abscess,
- Cavernous Sinus thrombosis

12. Investigations
1. T.C.D.C,ESR
2. CT orbit, sinus, brain
3. Blood, nasal, conjunctival and
throat culture and sensitivity

13. Treatment
1. Broad spectrum antibiotic
2. N.S.A.I.D
3. Steroids
4. Close monitoring by ophthalmologist, neuro
surgeon, ENT surgeon
5. Surgical – drainage of the abscess, biopsy,
orbital decompression.

14. Cavernous Sinus Thrombosis
■ Infection and thrombosis from the face,
■
■
■
orbit, mouth, pharynx, ear, nose and
sinuses can spread to the cavernous sinus
The superior ophthalmic vein connects the facial
veins to the cavernous sinus
One branch of the inferior ophthalmic vein connects
the orbit with that of the cavernous sinus.
The sinus of the one side communicates with the other
side
■ The whole venous system in this area is devoid of
valves.

16. Clinical features
■ Swelling of the lids and chemosis
■ Proptosis, impaired motility
■ Pain, diplopia, fever, headache, altered
sensorium, rigors, vomiting, severe cerebral
symptoms

17. the fellow eye is affected in 50% of cases
■
■
■
Papilledema and involvement of the orbital veins are
common in cases of otitis media and meningitis and
cerebral abscess
Edema in the mastoid region behind the ear indicates
thrombosis of the emissary veins

18. Clinical features –cont.,
■ Severe supra orbital pain
■
■
■
-due to involvement of
ophthalmic division of
the trigeminal nerve
paralysis of the opposite
lateral rectus is the first
sign of spread(VI nerve)
Paresis of
oculomotor(III) nerves
Late stages the eye is
immobile ,pupil is not
acting and cornea is
anaesthetised(V nerve)

19. Treatment
■ Intra venous broad spectrum antibiotics
■ Anti coagulants
■ Treatment of the cause if it is known
■ Steroids if there is no contra indications
■ A team effort of neurologists ,ENT specialists
and ophthalmologists are needed

20. Thank you