Non-visual complications of orbital cellulitis (NVCOC) in pediatric vs adult populations

PURPOSE

There have been many publications evaluating the visual outcomes of patients treated for orbital cellulitis. The aim of this study was to evaluate non-visual complications of post-septal orbital cellulitis (NVCOC) present 30 days after discharge from index hospitalization.

METHODS

This was an IRB-approved, retrospective chart review.

RESULTS

Ninety patients (45 pediatric, 45 adults) were identified with OC. NVCOC were significantly more common in adult patients as compared to children (40.0% vs 15.6% respectively; p < 0.05). The most common NVCOC among children was persistent ptosis, while clinically significant scarring was most common in adults. NVCOC were less persistent in children as compared to adults with 71.4% of complications in children resolving spontaneously by 6 month follow up as compared to 11.1% adults. (p < 0.05). The only statistically significant risk factor identified for the development of NVCOC in children and adults was the presence of ICE (intracranial extension) during index hospitalization (p < 0.05) and the presence of an infected orbital implant (p < 0.05) respectively.

CONCLUSIONS

Adult patients experience NVCOC complications more often than children. Furthermore, the nonvisual complications in children are more likely to resolve spontaneously than those in adults. The intracranial spread of infection is a significant risk factor for late complications in children. The presence of an orbital wall/floor implant is a significant risk factor for late complications in adults. There are many differences in the etiology, pathophysiology, and course of NVCOC in children and adults, so information on these two populations should be reported separately.

Orbital cellulitis with panophthalmitis and scleral necrosis - a case report

BACKGROUND

Orbital cellulitis is common in young children and is often secondary to coexisting sinus disease. Coexisting orbital cellulitis and panophthalmitis is a rare clinical event and usually occurs secondary to trauma or from an endogenous source.

CASE PRESENTATION

A febrile 2-year-old male presented with periorbital inflammation and exudative retinal detachment. Imaging showed acute sinusitis and extensive orbital cellulitis. Because of progressive scleral thinning, the patient underwent enucleation.

CONCLUSION

We present a case of concurrent orbital cellulitis, panophthalmitis, and scleral necrosis in an immunocompetent pediatric patient. Timely intervention is important to prevent life threatening complications with the rare occurrence of coexistent orbital cellulitis and panophthalmitis.

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.

Orbital Cellulitis Following Uncomplicated Glaucoma Drainage Device Surgery: Case Report and Review of Literature

Purpose

Orbital cellulitis (OC) is a rare postoperative complication of glaucoma drainage device (GDD) implantation. To date, there have only been 10 reported cases of OC following GDD implantation.

Case Report

Here, we report a case of OC in a 57-year-old man who developed pain, proptosis, and limited extraocular motility two days after uneventful Ahmed FP7 implantation in the right eye. Contrast-enhanced computed tomography of the orbits demonstrated fat stranding and a small fluid collection, consistent with OC. He had minimal improvement with intravenous antibiotics and ultimately underwent GDD explantation. A systematic review of the literature showed that the development of OC following GDD implantation can occur in the early or late postoperative period. Immediate hospitalization with intravenous administration of broad-spectrum antibiotics is recommended. Explantation of the infected GDD is often required for source control.

Conclusion

OC is a rare postoperative complication of GDD implantation. Prompt evaluation and treatment are required, often combined with GDD explantation.

Paediatric orbital cellulitis and the relationship to underlying sinonasal anatomy on computed tomography

OBJECTIVE

To assess if there is an association between sinonasal anatomical variants and the risk of developing orbital cellulitis and associated complications, in children.

METHODS

A retrospective case-control series was conducted, examining computed tomography confirmed sinonasal anatomical variants of septal deviation and concha bullosa in children who presented with periorbital cellulitis who went on to develop orbital cellulitis and abscesses.

RESULTS

Thirty children had a Chandler score of 2 or greater on computed tomography. Mean age was seven years and there was relatively equal sex distribution. There was no association between presence of concha bullosa and side of disease (odds ratio = 1), and no statistically significant difference between septal deviation and ipsilateral orbital infection (p = 0.125).

CONCLUSION

There was no statistical correlation between any sinonasal bony or cartilaginous anatomical variants on computed tomography and orbital complications of acute rhinosinusitis in our paediatric cohort. The findings do not support the theory that these anatomical variants predispose to orbital cellulitis occurring in these children, nor complications thereof.

The hot orbit: orbital cellulitis

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.

Understanding pediatric bacterial preseptal and orbital cellulitis

Pediatric preseptal and orbital cellulitis are infectious disorders that result in periorbital inflammation. Preseptal cellulitis is often associated with breaches in the skin barrier whereas orbital cellulitis is commonly associated with paranasal sinusitis. Orbital cellulitis may be associated with subperiosteal abscess. It is important to distinguish between preseptal from orbital cellulitis. Clinical examination and diagnostic imaging are useful in determining appropriate management. Patients are usually treated with broad spectrum antibiotics and surgery when indicated.