Orbital cellulitis: review of 23 cases from Saudi Arabia

Reconstruction of Orbital Wall Fractures with a Combination of Resorbable Plates and Antibiotic-Impregnated Collagen Sheets

(1) Background: Orbital wall fractures are common in maxillofacial trauma, and artificial implants are often used for reconstruction. However, there has always been concern about infection because implants are directly exposed to the airway. This study was conducted to determine the effectiveness of a combination of resorbable plates and antibiotic-impregnated collagen sheets in reconstructions of orbital fractures and to determine whether it had an effect in reducing postoperative antibiotic use. (2) Methods: The retrospective study was conducted on 195 patients who underwent orbital wall reconstruction from March 2019 to August 2022. The 176 patients in the control group underwent reconstruction using only resorbable plates and were administered postoperative antibiotics for 5 to 7 days. On the other hand, the 19 patients in the experimental group underwent reconstruction using a combination of resorbable plates and antibiotic-impregnated collagen sheets and only received antibiotics once before surgery. The occurrence of ocular complications, the length of hospitalization, the infection incidence rate, and the adverse effects of antibiotics were investigated. (3) Results: significant ocular complications were observed in the experimental group during a follow-up period of more than 1 year. Regarding postoperative infections, there were two cases of infection in the control group (infection rate: 1.14%), while no infection was found in the experimental group. The hospitalization period of the experimental group was significantly shorter than that of the control group (p < 0.01), and the incidence of total adverse effects of antibiotics, especially nausea, was lower in the experimental group (p = 0.02). (4) Conclusions: The combined use of resorbable plates and antibiotic-impregnated collagen sheets allows effective orbital wall reconstruction without infection, with a shorter hospital stay, and with fewer antibiotic adverse effects.

Clinical Characteristics and Risk Factors for Evisceration in Trauma-Dominant Orbital Cellulitis: A 10-Year Review

Purpose

To analyze the clinical characteristics of trauma-dominant orbital cellulitis (OC) and evaluate the risk factors associated with evisceration.

Methods

This retrospective study included inpatients diagnosed with orbital cellulitis at the Zhongshan Ophthalmic Center between January 2010 and December 2020. The demographic features, etiology, clinical characteristics, microbiological isolates, and risk factors associated with evisceration were analyzed.

Results

Among 148 consecutive subjects (n = 148, 148 eyes), the mean age was 42.07 ± 20.35 years and 70.27% were male. Penetrating globe injuries were the most common (52.03%). No light perception (NLP) was recorded in 50% of patients on admission. Endophthalmitis was observed in 103 cases (69.59%), intraocular foreign bodies (IOFB) were detected in 43 cases (29.05%), and total corneal melting was observed in 31 cases (20.95%). Sixty patients (40.54%) underwent evisceration. Logistic regression analysis showed that total corneal dissolution [odds ratio (OR) = 83.019, P = 0.000], IOFB (OR = 3.402, P = 0.016), and NLP (OR = 0.185, P = 0.001) were risk factors for evisceration. Microorganism detection showed that Pseudomonas aeruginosa and Bacillus cereus were the leading pathogens.

Conclusion

Among hospitalized trauma-dominant OC patients, middle-aged men were the major subjects and penetrating globe injury was the major cause. Significant complications such as complete visual loss and evisceration were unavoidable in many patients with OC in the current study. NLP, IOFB, and total corneal melting were the risk factors for evisceration.

Microbiology and outcome of pediatric orbital cellulitis in a Tertiary Eye Care Center in Saudi Arabia after the routine administration of Haemophilus influenzae Type B vaccine

PURPOSE

To evaluate the incidence of pediatric Haemophilus influenzae related orbital cellulitis after the routine administration of the H. influenzae vaccine in Saudi Arabia and to identify the most common pathogens, predisposing factors, related complications, and the need for surgical intervention.

METHODS

A retrospective chart review was performed of patients with a discharge diagnosis of orbital cellulitis who presented to the King Abdul Aziz University Hospital, Riyadh, Saudi Arabia. Saudi children born between 2000 and 2016 were included.

RESULTS

Thirty-one cases were included and 8 had positive cultures. No cases of H. influenzae were found. Of all the positive culture, the most common pathogens isolated were Staphylococcus aureus, Streptococcus pneumoniae and group A Streptococcus in 3 cases (37.5%), 2 cases (25%) and 2 cases (25%). The most common predisposing factor was sinusitis in 90.3% of cases. Sixteen patients (51.6%) developed complications. Fifteen patients (48.3%) developed subperiosteal abscesses, 1 patient (3.22%) developed a lid abscess, 2 patients (6.45%) developed recurrent orbital cellulitis, and 1 patient (3.22%) developed persistent strabismus. Only 10 (31.25%) patients underwent surgical intervention during admission.

CONCLUSION

The vaccine seems to be effective at eliminating the orbital cellulitis potentially related to H. influenzae. The most common current pathogens were Gram-positive Staphylococcus and Streptococcus species. Sinusitis remains the most common cause of orbital cellulitis in children. In select cases, medical treatment can resolve the infections however, close observation is warranted.

Orbital Infection Due to Medial Wall Fracture: Three Cases of Orbital Complications Caused by Paranasal Sinusitis Secondary to Medial Orbital Wall Fracture

PURPOSE

The aim of this study was to report 3 cases of orbital complications in patients with secondary sinusitis due to medial orbital wall fracture. We believe that sinusitis can be secondary to the fracture of the medial orbital wall when the sinus drainage orifice is blocked due to some fracture pieces or other blocking factors. We precisely show the direct evidence of the blocking factors through radiology.

DESIGN

Retrospective, noncomparative, interventional case series.

PARTICIPANTS

All patients had intraorbital complications and a history of traumatic orbital medial fracture as well as imaging findings of sinusitis.

METHODS

A medical record review of clinical history, imaging studies, and surgical and treatment outcomes were performed.

MAIN OUTCOME MEASURES

Postoperative visual acuity, appearance, eye movement, surgical and imaging findings.

RESULTS

Three patients (2 males and 1 female; average age 38.33 years [range, 11-65]) received endoscopic surgery for orbital complications related to sinusitis. All patients had evidence of paranasal sinusitis after the orbital injury. Two patients were treated with antibiotics before the operation, but there was no significant improvement. All patients underwent transnasal endoscopic sinotomy. Two patients received orbital abscess incision and drainage surgery and 1 patient underwent a cyst excision operation. The visual acuity of the 3 patients was improved after the operation, and the clinical examination was significantly improved.

CONCLUSIONS

The anatomy of the orbit is closely related to the nasal cavity. The fracture of the medial orbital wall often causes abnormal anatomy of the sinus outflow tract. For the 3 of our patients, the blocking factors of sinus orifices were fracture fragment, orbital bone deformation, and the formation of giant nasal intraorbital mucocele. Sinusitis possibly occurs when drainage is not smooth. Infections develop due to the secretions retaining and accumulation of microorganisms. Inflammation from the sinus can be spread into the orbit in various ways. Our 3 patients indicate that a fracture of the inner orbital wall may cause sinusitis. When the patient is injured again or sneezing or in other conditions when the pressure in the nasal cavity increases, inflammation of the sinuses enters the orbit, causing serious intraorbital complications. It is necessary to carefully follow-up on the medical history, combined with imaging examination, to prevent the misdiagnosis of intraorbital hemorrhage or hematoma from affecting the treatment.In recent years, more and more cases of intraorbital complications caused by sinusitis have been reported.1,2 Severe intraorbital inflammation can pose a threat to vision and even life. With the great tool of the endoscope, nasal-orbital problems can be well solved. For our 3 patients, we opened the paranasal sinus and removed the occlusion of the sinus orifice through transnasal endoscopy. All patients achieved good surgical and clinical results.

Common Orbital Infections ~ State of the Art ~ Part I

Infections of the orbit and periorbita are relatively frequent, and can cause significant local and systemic morbidity. Loss of vision occurs in more than 10% of patients, and systemic sequelae can include meningitis, intracranial abscess, and death. Numerous organisms infect the orbit, but the most common are bacteria. There are many methods through which orbital infections occur, with infection from the neighboring ethmoid sinuses the most likely cause for all age groups. Prompt management is essential in suspected orbital cellulitis, and involves urgent intravenous antibiotics, rehydration, and treatment of any co-existent underlying systemic disease, e.g., diabetes, renal failure. This review summarizes the common infectious processes of the orbit in both pediatric and adult groups. We review pathophysiology, symptoms, signs, and treatment for infectious orbital processes.

Clinical profile and outcomes of management of orbital cellulitis in Upper Egypt

Background

The purpose of this paper is to study the etiology, clinical findings, and outcomes of management of cases of orbital cellulitis treated in Minia University Hospital in Upper Egypt over the period of 6 years from July 2009 to July 2015. One-hundred two patients diagnosed to have orbital cellulitis were admitted to the hospital and treated on inpatient basis from July 2009 to July 2015. All patients were subjected to full ophthalmological examination, systemic evaluation, and ear, nose, and throat (ENT) consultation. Axial and coronal CT scan and orbital echography were done for all patients. All patients received medical treatments, and 20 patients needed surgical intervention.

Results

The source of infection was paranasal sinusitis in 66 patients, trauma in 14 cases, panophthalmitis in 6 patients, and dental infection in 2 cases, and no definite source was detected in 14 cases. Subperiosteal abscess (SPA) developed in 16 patients. The final best corrected visual acuity improved in 58% of the cases, decreased in 4%, and remained unchanged in 38% of cases. No intracranial complication was recorded.

Conclusions

Good presenting visual acuity and appropriate medical treatment together with early surgical intervention in cases of SPA are important factors to achieve favorable outcomes in orbital cellulitis. All cases with SPA had paranasal sinusitis, and contrary to previous studies, superior SPA location was the most common followed by the medial location.

[Orbital cellulitis: prospective study about 75 cases]

Les cellulites orbitaires est une affection grave par ses complications aussi bien locales, locorégionales que générales, pouvant engager le pronostic vital et fonctionnel, surtout lorsque le diagnostic est tardif et la prise en charge inappropriée. Le but de cette étude est de décrire les aspects épidémiologiques, cliniques, thérapeutiques et évolutifs des cellulites orbitaires et d'insister sur la nécessité d'un diagnostic et d'un traitement précoces, afin d’éviter ses complications. Il s'agit d'une étude prospective concernent 75 patients présentant une cellulite orbitaire, menée au service d'Ophtalmologie et d'ORL au CHU Mohammed VI de Marrakech, de Septembre 2010 au Avril 2014. L’âge moyen des patients était de 24 ans allant de 2 ans à 70 ans. La porte d'entrée était dominée par l'atteinte sinusienne retrouvée chez 43 malades. L'examen ophtalmologique a montré une BAV chez 20% des patients avec une cécité bilatérale chez un patient et unilatérale chez 3, un chémosis (82%), une exophtalmie (85,71%), un ptosis (30%), une ophtalmoplégie (66%), une fistule orbitaire (4 cas), et une kératite d'exposition chez 8 cas. L'analyse des résultats tomodensitométriques a noté: 24 cas de cellulite pré septale (45%), 20 cas de cellulite orbitaire (15%), 2 cas d'abcès sous périosté (5%) et 14 cas d'abcès orbitaire (35%). 20 patients ont bénéficié d'un traitement chirurgical associé au traitement médical, ayant consisté en un drainage de l'abcès orbitaire dans 24 cas, une ethmoidectomie antérieure par voie endoscopique avec drainage d'un abcès sous-périosté dans 2 cas à et un drainage d'une collection abcédée des parties molles dans 6 cas. La cellulite orbitaire est une urgence thérapeutique qui met en jeu le pronostic visuel et vital. Causés le plus fréquemment par les traumatismes oculaires post chirurgicale ou AVP, les sinusites, les fractures orbitaires, et les corps étrangers intraoculaires. Les infections rétro-septales sont les plus graves, nécessitant une exploration par imagerie en coupes. L’évolution de la cellulite orbitaire est toujours grave en l'absence d'un traitement médical et chirurgical strict. Le traitement précoce et adapté représente un élément pronostique très important. Les cellulites orbitaires est une affection grave pouvant engager le pronostic vital et fonctionnel, surtout lorsque le diagnostic est tardif et la prise en charge inappropriée.

[Orbital cellulitis complicating acute pansinusitis: report of a case]

Les cellulites orbitaires sont des affections peu fréquentes. Ces infections peuvent être secondaire à une infection oculaire, péri oculaire ou à une septicémie. L'origine sinusienne reste la plus fréquente. Le risque de graves complications mettant en jeu le pronostic fonctionnel et vital nécessite un diagnostic rapide et une prise en charge précoce. Nous rapportons le cas clinique d'une femme de 70 ans connue diabétique, qui a présenté une cellulite orbitaire secondaire à une pansinusite négligée. Le traitement était à la fois médical et chirurgical: antibiothérapie et drainage. L’évolution a été favorable au bout du septième jour. Nous essayons à travers ce cas clinique de souligner la gravité des infections orbitaires et leurs conséquences dramatiques en cas de retard de prise en charge.

Nine years' review on preseptal and orbital cellulitis and emergence of community-acquired methicillin-resistant Staphylococus aureus in a tertiary hospital in India

Context:

Preseptal cellulitis is the commonest orbital disease which frequently needs to be differentiated from orbital cellulitis. Prompt diagnosis and treatment with appropriate antibiotics can prevent vision loss and life-threatening complications of orbital cellulitis.

Aims:

To describe the clinical profile of cases with preseptal and orbital cellulitis admitted to a tertiary care hospital during a period of nine years. The causative organisms and the clinical outcome were analyzed.

Settings and Design:

Retrospective descriptive case study done in a tertiary care hospital in South India.

Material and Methods:

The in-patient records of patients with preseptal and orbital cellulitis were reviewed from 1998 to 2006. The factors reviewed included ocular findings aiding in the distinction of the two clinical conditions, the duration of symptoms, the duration of hospital stay, microbiological culture report of pus or wound swab, blood culture, drugs used for treatment, the response to therapy and complications.

Statistical Analysis Used:

Descriptive analysis.

Results:

One hundred and ten cases, 77 patients with preseptal cellulitis and 33 patients with orbital cellulitis were reviewed. Five percent of children and 21% of adults presented with cutaneous anthrax contributing to preseptal cellulitis. Thirty-nine percent cases with orbital cellulitis were caused by methicillin-resistant Staphylococcus aureus (MRSA).

Conclusions:

This study has helped in identifying organisms which cause orbital infections, especially community-acquired MRSA. It indicates the need for modifying our empirical antimicrobial therapy, especially in orbital cellulitis.

[Orbital cellulitis]

Orbital cellulitis is uncommon in ophthalmologic practice. The majority of cases arise from direct spread of sinus infection or eyelid infection. Clinically, orbital cellulitis is divided into two forms: the preseptal form, anterior to the orbital septum, and the retroseptal form, posterior to the orbital septum. Management and prognosis differ widely between the two types. The retroseptal form or "true" orbital cellulitis is a severe disease with potentially disastrous consequences for vision and survival. Clinical examination and urgent CT scanning are indispensable for correct diagnosis, evaluation of severity, surgical planning and antibiotic selection.

The spectrum of cavernous sinus and orbital venous thrombosis: a case and a review

Orbital venous pathologies encompass a broad range of entities including tumors, shunts, congenital anomalies, aneurysms, and obstructive lesions. Patients may present with a variety of clinical findings which may include a combination of tumefaction, vascular engorgement, orbital pulsation, and exophthalmos, depending on the relationship between the lesion and the vascular system. Clinical findings may be unreliable in excluding serious underlying disorders, and so an extensive clinical and radiologic evaluation is necessary. This article presents a rare case of spontaneous aseptic cavernous sinus-superior ophthalmic vein thrombosis in a woman on hormone replacement therapy, and illustrates the multidisciplinary approach in diagnosis and management. The literature on issues surrounding this case is reviewed.

Clival inflammation with cavernous sinus thrombophlebitis and orbital subperiosteal abscess--case report

A 64-year-old woman presented with a very rare case of three infectious lesions, cavernous sinus thrombophlebitis, clival inflammation, and orbital subperiosteal abscess (SPA), manifesting as abducens palsy. An isolated non-specific mass in upper clivus was initially suspected to be derived from paranasal sinusitis. The clival lesion was approached by an endonasal transsphenoidal route and diagnosed as inflammation. However, progressive enlargement of an orbital mass was recognized, with eyelid erythema and swelling. Magnetic resonance imaging showed massive paranasal sinusitis and an intra-orbital mass, which was proved to be an orbital SPA by open surgery. Cavernous sinus thrombophlebitis might have been caused by primary paranasal sinusitis, and the origin of orbital cellulitis was suspected to be cavernous sinusitis based on the preoperative radiological findings. These unusual lesions should be kept in mind as one of the differential diagnoses.

Orbital abscess with unusual features

PURPOSE

To report a series of 7 cases of orbital abscess with unusual features that may mimic other cystic orbital lesions.

METHODS

Retrospective study of all cases of orbital cellulitis/abscess treated at our center, over 1 year, highlighting cases with unusual features.

RESULTS

Thirty-one cases were studied, where orbital cellulitis/abscess was the final diagnosis. Of these, 7 patients did not have typical signs and/or symptoms of local infection. At presentation, there was no associated predisposing risk factor, indicating the source of infection. The duration of symptoms, among these 7 patients, ranged from 3 weeks to 6 months. The initial diagnosis was myocysticercosis in 3 cases, orbital dermoid in 1 case, lymphangioma in 1 case, pseudotumor in 1 case, and schwannoma in 1 case.

CONCLUSIONS

Unusual presentations of orbital abscess can mimic other conditions of the orbit. Orbital abscess should be considered in the differential diagnosis if a cystic lesion has not responded or partly responded to systemic antibiotics and there are associated signs or symptoms of intermittent or constant low-grade inflammation, even in the absence of predisposing risk factors.

[Orbital infections in children: clinical signs, imaging, and treatment]

Orbital infections are rare in children. The more posterior the abscess has spread, the more serious it is, with potential intracranial complications. The main etiology is sinusitis, whose location depends on age. The diagnosis is based on clinical examination and CT or MRI. Intravenous antibiotics alone or associated with surgical drainage (for children older than 9 years or those with complications) are performed. Orbital infections in children require good collaboration between ophthalmologists, otolaryngologist, and pediatricians.

Dental infection presenting with ipsilateral parapharyngeal abscess and contralateral orbital cellulitis - a case report

A 43 year-old man presented with pain on the right tooth for three days duration. Computed tomography showed left orbital cellulitis and right parapharyngeal abscess. There was also evidence suggestive of a dental abscess over right upper alveolar region. Magnetic resonance imaging revealed left superior ophthalmic vein thrombosis. Emergency drainage of the right parapharyngeal abscess was performed. Right maxillary molar extraction revealed periapical abscess. Left eye proptosis markedly reduced after initiating heparin.

Preseptal and orbital cellulitis in a developing country

PURPOSE

To report the clinical features, etiology, management practices, and outcomes of preseptal (PC) and orbital cellulitis (OC) in a developing country.

METHODS

The charts of all patients with PC and OC at the Philippine General Hospital from 1990 to 1995 were reviewed and the following data retrieved: age, gender, manner of presentation, causative agent, treatment, and outcomes.

RESULTS

Of 91 patients, 56 (62%) were diagnosed with PC and 35 (38%) with OC. The mean age at presentation was 12.6 +/- 17.0 years and 17.1 +/- 18.6 years, respectively. No sex predilection was observed. Ophthalmoplegia, chemosis, pain, proptosis, and blurred vision were associated with OC. Eyelid infection was the most common antecedent factor and was present in 15 (27%) PC patients and 13 (37%) OC patients. Staphylococcus was the most frequent causative organism. Intravenous antibiotics were administered to 35 (62%) PC patients and all patients with OC. Surgical intervention was performed in 15 (27%) PC patients and 22 (63%) OC patients. None of the PC patients developed permanent sequelae. Seventeen (49%) OC patients developed serious complications such as: visual loss (29%), neurological deficits (17%), and mortality (3%).

CONCLUSIONS

In developing countries, eyelid infection may be the most important predisposing factor for periocular infection. Staphylococcus is the predominant causative agent. OC can be associated with serious complications. Aggressive management of OC may improve patient outcomes.

Outcome of Treated Orbital Cellulitis in a Tertiary Eye Care Center in the Middle East

PURPOSE

To describe risk factors predisposing patients to orbital cellulitis and potential complications in patients treated at a tertiary eye care referral center in the Middle East.

DESIGN

Noncomparative, interventional, retrospective case series.

PARTICIPANTS

Patients diagnosed with orbital cellulitis.

METHODS

A 15-year clinical review of patients with a diagnosis of orbital cellulitis referred to King Khaled Eye Specialist Hospital, an accredited (Joint Council on Accreditation of Healthcare Organizations, Washington, DC) tertiary care center in Riyadh, Saudi Arabia, was performed. Only those patients who had clinical signs and symptoms or radiologic evidence suggestive of orbital cellulitis were included in the study.

MAIN OUTCOME MEASURES

Patient demographics, factors predisposing to orbital cellulitis, and resulting complications.

RESULTS

A total of 218 patients (136 male, 82 female) fulfilling the diagnostic criteria for orbital cellulitis were identified. The average age of these patients was 25.7 years (range, 1 month-85 years). On imaging studies, there was evidence of inflammatory or infective changes to orbital structures; orbital abscesses were identified in 116 patients (53%). Sinus disease was the most common predisposing cause in 86 patients (39.4%), followed by trauma in 43 patients (19.7%). All patients received systemic antibiotic treatment before the identification of any responsible organisms. Of the 116 patients with orbital abscess, 101 patients (87%) required drainage. The results of cultures in patients in whom an orbital abscess was drained were positive for 91 patients (90%). The most common microorganisms isolated from the drained abscesses were Staphylococci and Streptococci species. Blood cultures were positive in only 4 patients from whom blood was drawn for cultures. Visual acuity improved in 34 eyes (16.1%) and worsened in 13 eyes (6.2%), including 9 (4.3%) eyes that sustained complete loss of vision, which was attributed to the delay in correct diagnosis and timely intervention (average 28 days vs. 9 days in patients with no loss of vision; P<0.05). There were 9 cases of intracranial extension of orbital abscesses that required either extended treatment with systemic antibiotics alone or in combination with neurosurgical intervention. Most patients received oral antibiotics on discharge for varying periods. There were 6 cases (2.7%) of strabismus and 4 cases (1.8%) of ptosis that persisted after treatment and resolution of orbital cellulitis.

CONCLUSIONS

Untreated sinusitis and prior history of orbital trauma were the 2 major causes of orbital cellulitis in patients referred to a tertiary care eye center in the Middle East. Although rare, severe visual loss still remains a serious complication of delayed detection and intervention in most cases of orbital cellulitis.

Preseptal and orbital cellulitis: a 10-year review of hospitalized patients

BACKGROUND

Preseptal and orbital cellulitis range in severity from minor to potentially severe complications. The purpose of this study is to describe the clinical features of patients with preseptal or orbital cellulitis in one medical center in Taiwan, and to assess the effectiveness of treatments and the complications.

METHODS

Patients admitted between 1996 and 2005 to Taipei Veterans General Hospital under the diagnosis of preseptal or orbital cellulitis were retrospectively reviewed. The demographics, administrative history, past history, clinical presentations, treatments, and complications were analyzed.

RESULTS

In total, 94 patients fulfilling the diagnostic criteria for preseptal or orbital cellulitis were identified (67 had preseptal cellulitis, 27 had orbital cellulitis). While paranasal sinus disease was the most common predisposing cause in orbital cases, skin lesions in children and dacryocystitis in adults were the most common in preseptal cases. Microbiologic investigations showed variable results, but the most common pathogen isolated was Staphylococcus aureus. Cultures from eye swabs and local abscesses gave the highest positive yield. Blood cultures were taken in some patients, but the positive rate was extremely low. Treatments included intravenous antibiotics alone, or intravenous antibiotics combined with surgical drainage. Only one case had permanent ocular motility impairment after removal of the orbital foreign body.

CONCLUSION

Despite the past history of potential morbidity and even mortality from orbital cellulitis, early diagnosis and prompt treatment with proper antibiotics and/or surgical intervention can achieve a good prognosis.

Une expérience sénégalaise des cellulites orbitaires

AIM

To show the etiological, clinical, and epidemiological aspects of orbital cellulitis at the ophthalmological clinic of A. le Dantec hospital.

PATIENTS AND METHOD

This is a retrospective study conducted from January 1994 to October 2003. Sixty-eight patient records were used. We noted patients' civil status, past medical history, clinical and paraclinical examinations, treatment received before and at admission to the clinic, and progression.

RESULTS

The incidence of orbital cellulitis was 8.9 cases per year. The average age of patients was 18 years and the sex ratio 2.78 in favor of males. Patients were hospitalized for a mean of 11 days. The fever was often stopped at admission. All patients had violent retrobulbar pain, associated with inflammatory exophthalmos in 77.8% of cases, and ophthalmoplegia in 67.2%. Two cases of diplopia were noted; 57.5% had sinusitis. Streptococcus was the bacterium found most frequently. In hospital, all patients received three antibiotics (ampicillin, aminoglycoside, metronidazole) and prednisone. In 51.5% of the cases, surgical treatment was necessary. Progression was favorable in 55.88% of the cases. Three patients died and 18 cases of blindness were noted.

CONCLUSION

Orbital cellulitis is a young people's disorder with serious complications. This medical emergency requires a combination of effective antibiotics and a corticosteroid. Treating the source of infections is essential to avoid recurrence. In our practice, these three drugs in association in first intention was beneficial without an antibiogram.

Orbital cellulitis: a rare complication after orbital blowout fracture

PURPOSE

To report the incidence of orbital cellulitis after orbital blowout fracture.

DESIGN

Retrospective, noncomparative, interventional case series.

PARTICIPANTS

All patients with orbital cellulitis and a history of recent orbital fracture.

METHODS

A medical record review of clinical history, imaging studies, and surgical and treatment outcome was performed.

MAIN OUTCOME MEASURES

Resolution of orbital cellulitis and surgical and imaging findings.

RESULTS

Four patients (3 male; mean age, 30 years [range, 4.5-58]) were treated for orbital cellulitis complicating orbital fracture. All patients had evidence of paranasal sinusitis before or after the orbital injury, and 2 also reported forceful nose blowing after sustaining orbital trauma. Although 3 patients received prophylactic oral antibiotics after the fracture, this failed to prevent infection. Sinusitis commenced 1 to 2 weeks before and as late as 5 weeks after orbital injury. All patients were treated with IV antibiotics. Two developed an orbital abscess that required surgical drainage; 1 patient improved after an endonasal maxillary antrostomy. One patient improved on IV antibiotics alone and underwent fracture repair at a later stage. These 4 patients represent 0.8% of all cases of orbital fractures treated in the study period.

CONCLUSIONS

Orbital cellulitis is a rare complication of orbital fracture, and seems to be more common when paranasal sinus infection preexists or occurs within several weeks of the injury. Oral antibiotics given after the orbital injury may not prevent orbital cellulitis or abscess formation. Surgery may be required to drain orbital abscess or in nonresolving cellulitis to drain the paranasal sinuses. Fracture repair, if indicated, should be delayed, particularly if an alloplastic implant is used.

Necrotising orbital cellulitis

PURPOSE

To report 2 cases of severe necrotising orbital cellulitis which illustrate the need for aggressive surgical management to prevent blindness.

METHODS

The case records of 2 patients with necrotising orbital cellulitis were reviewed.

RESULTS

Both patients had orbital cellulitis associated with sinusitis. Each case was characterised by the rapid development of severe systemic toxicity, extensive soft tissue necrosis and abscess formation. One patient developed panophthalmitis and the eye had to be eviscerated. The other patient underwent repeated surgical drainage of multiple orbital abscesses. This led to resolution of the infection and preservation of vision.

CONCLUSIONS

Atypical rapidly progressive necrotising orbital cellulitis may occasionally be encountered. In such cases, aggressive surgical drainage of orbital abscesses is crucial to prevent blindness and death.

Periorbital cellulitis: a comparison of different treatment regimens

Periorbital cellulitis was retrospectively investigated in a cohort of 69 children, 1.5-16 years of age, who were admitted to Hacettepe University Children's Hospital. The aim of the study was to define the most important cause of the disease and to choose the most appropriate antimicrobial regimen. Sinusitis (43%) was found to be the most frequent disease associated with periorbital cellulitis. Trauma (25%) and odontogenic infections (6%) were the next most common predisposing causes. Staphylococcus aureus was isolated from 14 (74%) of 19 cultures. Two antibiotic combinations, penicillin plus chloramphenicol and sulbactam-ampicillin (SAM) with or without ornidazole was used in 30 (43%) and 39 (57%) of 69 cases, respectively. The duration of treatment with these two antibiotic combinations was generally between 7 and 10 days. No statistical difference was found between the two antibiotic combinations in the cure and recurrence rates but five (17%) of the 30 cases using penicillin plus chloramphenicol, and one (3%) of the 39 cases using SAM with or without ornidazole had recurrent periorbital cellulitis. It was concluded that SAM can be the first line of drug treatment for periorbital cellulitis as it is easily used in every age group and etiology (trauma, sinusitis, etc.). It provides total recovery and has less side effects and risk of recurrence. It also has a broad antimicrobial spectrum.

Orbital subperiosteal abscess and blindness complicating a minimally displaced zygomatic complex fracture

A case of orbital subperiosteal abscess (SPA) complicating a minimally displaced zygomatic complex (ZMC) fracture is reported and the aetiology and management of this potentially life-threatening condition is discussed. The value of CT scanning in staging orbital infection and determining the site of the abscess and involved paranasal sinuses is emphasised. The correct interpretation of a lateral skull radiograph with the patient brow up may have lead to earlier diagnosis and treatment.

Orbital cellulitis demands early recognition, urgent admission and aggressive management

Orbital cellulitis is an emergency. Confusion still exists between the diagnosis of this serious condition and that of preseptal cellulitis. Delay in treatment may cause blindness and progression to life-threatening sequelae such as brain abscess, meningitis or cavernous sinus thrombosis. We report a case in which, despite late referral, emergency surgical intervention was sight saving.

Orbital cellulitis--an unusual presentation and late complication of severe facial trauma

We report an unusual case of orbital cellulitis in a patient with only one seeing eye and severe facial asymmetry secondary to a road traffic accident twenty two years previously. Facial trauma sustained in the road traffic accident created continuity between the right orbit and the adjacent ethmoidal cells. The abnormal communication between the ethmoidal labyrinth and the right orbit rendered this patient highly susceptible to an orbital cellulitis from an adjacent paranasal sinus infection. However, this case is unusual with regard to the length of time that elapsed before such an infection became manifest and the presence of gross distortion of anatomy masked the usual presentation and thereby caused a delay in diagnosis.