The hot orbit: orbital cellulitis

Abstract

Orbital cellulitis is an uncommon condition previously associated with severe complications. If untreated, orbital cellulitis can be potentially sight and life threatening. It can affect both adults and children but has a greater tendency to occur in the pediatric age group. The infection most commonly originates from sinuses, eyelids or face, retained foreign bodies, or distant soources by hematogenous spread. It is characterized by eyelid edema, erythema, chemosis, proptosis, blurred vision, fever, headache, and double vision. A history of upper respiratory tract infection prior to the onset is very common especially in children. In the era prior to antibiotics, vision loss from orbital cellulitis was a dreaded complication. Currently, imaging studies for detection of orbital abcess, the use of antibiotics and early drainage have mitigated visual morbidity significantly. The purpose of this review is to describe current investigative strategies and management options in the treatment of orbital cellulitis, establish their effectiveness and possible complications due to late intervention.

Keywords: Diagnosis; Intracranial Extension; Management; Orbital Abscess; Orbital Cellulitis; Vision Loss.

Figure 1

External photograph of a 10-year-old male child who presented with right eyelid edema, swelling along with proptosis who was found to have evidence of ethmoiditis and maxillary sinusitis along with subperiosteal abscess requiring drainage

Figure 2

A 12-year-old female who presented with left upper eyelid swelling, pain and proptosis of left eye who was found to have evidence of panophthalmitis and superior orbital abscess. Soon after orbital abscess drainage, patient's upper eyelid swelling and diplopia resolved. Repeat CT-scan revealed evidence of the treated sinusitis as well as orbital abscess. Prior to discharge the patient complained of nausea, vomiting and lethargy. Repeat imaging studies CT-scan and MRI of orbits and brain revealed a sudural empyema and meningitis for which she was treated successfully

Figure 3

A 68-year-old male with diabetes presented with left eyelid swelling, proptosis, and decreased vision. Imaging studies revealed evidence of panendophthalmitis along with orbital cellulitis. Sinus surgery as well as evisceration revealed evidence of fungal infection

Figure 4

External photograph of a 27-year-old female patient who presented with left periocular edema, pain and decreased vision after a fall several days earlier. Imaging studies confirmed evidence of sinusitis and orbital fracture. Ultrasonography of her left eye revealed a stretched optic nerve along with compression on the eye. During exploration, an abscess was drained from the left lower eyelid that was connected to her maxillary sinus

Figure 5

External photograph of a 21-year-old female who was diagnosed with right-sided orbital abscess which did not undergo drainage. Chronically untreated orbital abscess resulted in erosion of her orbital wall and intracranial extension