Sinogenic Orbital Complications

Abstract

Background: The term "orbital complication" does not designate an independent nosological entity, but is rather a collective designation for diseases or disease effects that involve the orbit and its internal structures by extension from outside. In general, their most prominent manifestation is swelling of the orbital soft tissues, usually unilaterally. The incidence of sinogenic orbital complications is approximately 1.6 per 100 000 children and 0.1 per 100 000 adults per year.

Methods: This review is based on publications retrieved by a selective search of the literature on the epidemiology, diagnosis, and treatment of sinogenic orbital complications.

Results: Acute sinusitis is the most common cause of orbital complications. These are diseases of the orbit with potentially serious consequences for the eye and the risk of intracranial complications such as cavernous sinus thrombosis, meningitis, or brain abscess. Aside from acute sinusitis, many other infectious and non-infectious diseases can extend to and involve the orbit. Because of the complexity and severity of the condition, its diagnosis and treatment are always an interdisciplinary matter. The treatment is primarily conservative, under observation in a hospital, and generally consists of the treatment of acute sinusitis with measures to combat edema along with the administration of broad-spectrum antibiotics. Surgical intervention is needed in severe cases or if there is an abscess. An endonasal approach is usually used for drainage.

Conclusion: In 95-98% of cases in stages I-IV, healing is complete and without further sequelae. Even if vision is affected preoperatively, it usually recovers fully when therapy is appropriate. Approximately 15% of the patients who undergo surgery need more than one operative procedure.

Figure 1:

Proximity of the orbit to the paranasal sinuses (taken from [5], reprinted with kind permission of © Thieme Group)

Figure 2

Patient with an orbital complication secondary to acute right ethmoid sinusitis associated with considerable swelling of the orbital soft tissues.

Figure 3a

Computed tomography depicting a right subperiosteal abscess, originating from an ethmoid sinusitis in a 7-year-old child. Gas inclusions are evident within the abscess.

Figure 3b

Coronal computed tomography section of a 10-year-old boy with an abscess located in the cranio-lateral orbit, originating from a right frontal sinusitis. (Reprint of the two images with kind permission of Dr. J. Weidemann, Department for Pediatric Radiology and Ultrasound of the Pediatric Hospital auf der Bult, Hanover, Germany).