[Severe orbital cellulitis: therapeutic results in 9 patients and review of the literature]

Abstract

Background: Orbital cellulitis can produce severe neuromeningeal infections. Modern antimicrobial agents such as imipenem can be a valid therapeutical choice.

Methods: Patients with severe or complicated orbital cellulitis admitted to our hospital from 1986 through 1994 were retrospectively studied.

Results: Nine patients with severe orbital cellulitis, seven of them older than 14 years, are reported. Cellulitis was secondary to different forms of sinusitis in five of them. The incriminated microorganisms were: Streptococcus viridans alone or combined to gram negative bacilli (3 cases), Prevotella melaninogenica and other anaerobes (2 cases), Enterococcus faecalis and Staphylococcus aureus (one case each). Three patients developed brain abscesses, one an acute bacterial meningitis and another a subdural empyema. Eight patients underwent a surgical drainage. Seven patients were treated with IV imipenem at doses of 2-3 g/day with complete cure of the orbital cellulitis and of the associated infectious complications and no secondary effects. Two patients died.

Conclusions: Imipenem is an effective antibiotic in the combined medical-surgical treatment of the severe or complicated orbital cellulitis.