Preseptal and Postseptal Orbital Cellulitis of Odontogenic Origin

Orbital Cellulitis and Frontal Epicranial Empyema Secondary to Pansinusitis: A Case Report

Orbital cellulitis is a relatively uncommon complication of sinusitis. Its association with intracranial complications is rare. We present the case of a 36-year-old patient with no associated risk factors who presented with a four-day history of headache, periorbital inflammation, suppuration, and necrosis. A computed tomography (CT) scan revealed a frontal epidural abscess and signs of chronic pansinusitis. This case highlights the importance of maintaining a high index of suspicion for complications of this condition and the necessity of a multidisciplinary approach in managing this rare complication.

A rare ocular complication of septicemia: a case series report and literature review

BACKGROUND

Septicemia that leads to ocular involvement mostly presents as endophthalmitis or panophthalmitis. Contrarily, septicemia without intraocular involvement, known as hematogenous orbital cellulitis (HOC), involves only the orbit and is an extremely rare complication of septicemia and a rare type of orbital cellulitis.

CASE PRESENTATION

Four male patients with septicemia presented with orbital involvement without intraocular infection were described in this study. They were 22 (case 1), 15 (case 2), 79 (case 3), and 30 (case 4) years old, with a mean age of 29.75 years. All patients were immunocompromised except for case 2. Cases 1 and 3 had a history of steroid use, whereas case 4 was in a post-chemotherapy myelosuppression phase. Septicemia in case 1 was community-acquired, cases 3 and 4 were hospital-acquired, and case 2 was secondary to acne squeezing. Blood cultures from cases 1, 2, and 3 were positive for Candida albicans, methicillin-resistant Staphylococcus aureus, and Klebsiella pneumoniae, respectively. Case 4 had negative cultures; however, next-generation sequencing reported the presence of Enterococcus faecalis and Rhizopus oryzae. Case 1 had right eye involvement, and both eyes were involved in the other three cases. According to Chandler's classification, case 1 was type 2, case 2 was type 2 (OD) and type 4 (OS), and cases 3 and 4 were type 1 orbital infections. All patients had eyelids erythema, and cases 1 and 2 had mildly decreased visual acuity, proptosis, and painful and restricted ocular motility. Hospital stays ranged from 13 to 43 days (mean, 24 days). All patients received systemic antibiotic therapy based on drug sensitivity and next-generation sequencing results, in combination with multidisciplinary treatment, resulting in complete recovery of ocular and systemic signs and symptoms; no ocular surgical interventions were performed. Extraocular muscle palsy was the last symptom to resolve.

CONCLUSION

HOC is predominantly seen in immunocompromised individuals with a high proportion of hospital-acquired infections and positive cultures for pathogens. Infection control using systemic antibiotics targeted at the causative organism guarantees a favorable prognosis.

Fatal Orbital Cellulitis With Intracranial Abscess: A Case Report

Orbital cellulitis is a sight- and life-threatening condition. Prompt diagnosis and immediate intervention are required. We report a case of fatal odontogenic orbital cellulitis complicated with intracranial abscesses in a 55-year-old gentleman. The patient presented with painful swelling of the left eye associated with reduced eye movement, blurry vision, and a headache. There was generalized periodontitis. Initial imaging was suggestive of left eye orbital cellulitis with intracranial abscess, and intensive systemic antibiotic therapy was initiated. After six weeks of antibiotic therapy, there was an improvement in ocular signs and symptoms. However, the patient developed signs of meningism with a persistent fever. Serial brain imaging demonstrated worsening intracranial abscesses. The patient died eight weeks after the initial onset of presentation. This case emphasized that brain abscesses could be a fatal complication of odontogenic orbital cellulitis. A high index of suspicion is important in diagnosing orbital cellulitis and its complications. Early consideration of surgical intervention is necessary in cases not responding to antibiotic therapy.

Superior Optic Vein Thrombosis Related to Orbital Cellulitis Secondary to Aquatic Injury

A 52-year-old woman presented with orbital cellulitis and sixth cranial nerve palsy as a result of striking the tail of a stingray while swimming. Her ophthalmologic and neurologic examination showed injury of the conjunctiva, corneal abrasion without mention of foreign body, contusion of the eyelid, and isolated lateral gaze palsy and ptosis in the right eye. Orbital magnetic resonance (MR) imaging and MR venography showed orbital cellulitis, superior and lateral rectus edema, and thrombosis of the superior ophthalmic vein on the right eye. She was treated appropriately, and her physical examination showed significant improvement within three months.

Odontogenic orbital inflammation

Objective: This study aimed to determine the most frequent clinical aspects in patients with odontogenic orbital inflammation, the computed tomography (CT) aspect, and the most appropriate treatment. Material and Methods: This is a retrospective case-series study conducted on 3 patients with ages between 16 and 55 years old, in the Ophthalmology and Oro-Maxillo-Facial Clinics of "Sf. Spiridon" Emergency Hospital, Iași, Romania. The following investigations were performed in all selected cases: visual acuity (VA), ocular motility examination, anterior segment examination at slit-lamp, fundus examination, intraoral clinical examination, sinus and orbital involvement on CT scan, pathogens involved. Results: All three patients presented swelling of the genic and periorbital regions, conjunctival chemosis, hyperemia of the conjunctiva, proptosis, pain, decreased vision and extraocular movement restriction. The CT examination identified orbital and periorbital cellulitis and ethmoidal expanded maxillary sinusitis or pansinusitis. Dental extraction, transalveolar drainage and orbital decompression were performed in all three cases. The evolution was favorable with remission of proptosis, edema of the genic and periorbital regions and conjunctival chemosis. Visual acuity remained poor in one case due to total optic nerve atrophy. Conclusions: Our study had a small number of patients, but the data was pertinent to ophthalmologists and maxillofacial surgeons who need to be aware of typical clinical features and the most common etiologies. Late treatment of dental infections can lead to severe ocular manifestations such as orbital cellulitis. Odontogenic orbital inflammation management involves a long-term and multidisciplinary approach. Abbreviations: CT = computed tomography, VA = visual acuity, CBCT = cone beam computed tomography, TED = thyroid eye disease, MRI = magnetic resonance imaging, OOC = odontogenic orbital cellulitis, RAPD = relative afferent pupillary defect.