opthalmology

1. ORBITAL
CELLULITIS
IZAFA MIRNA

2.  Acute infection of the soft tissues of the orbit behind
the orbital septum
 May/may not progress to a subperiosteal/orbital
abscess

3. Etiology
Modes of infection
 Exogenous infection
 Result from penetrating injury
 Extension of infection from
neighbouring structures
 Paranasal sinuses, teeth,
face, lids, intracranial cavity,
intraorbital structures
 Endogenous infection
 Rarely develop as metastatic
infection from breast
abscess,etc.
Causative organisms
 Streptococcus pneumoniae
 Staphylococcus aureus
 Streptococcus pyogenes
 Haemophilus influenzae

4. Pathology
 Similar to suppurative inflammations of the body in
general except:
• d/t absence of lymphatics in the orbit
Infection establishes early
• Infections spreads as thrombophebitis from surrounding
structures
Rapid spread with extensive necrosis
• As orbital infection is ass. With raised intraorbital pressure
d/t tight compartment
Damage produced is rapid and extensive

5. CLINICAL FEATURES
 Symptoms
 Swelling and severe pain (increased by movements of
eyeball/pressure)
 Ass. General symptoms- fever, nausea, vomiting &
prostrations
 Visual loss &/ diplopia in moderate to advanced disease

6.  Signs
 Swelling of lids (woody hardness
& redness)
 Chemosis of conjunctiva (protrude
& become desiccated/necrotic)
 Axial proptosis
 Restriction of ocular movements
(mild-severe)
 RAPD –complications in the form
of optic neuropathy/CRAO
 Fundus examination –congestion
of retinal veins,
papillitis/papilloedema)

7. COMPLICATIONS
Ocular complications
* Exposure keratopathy
* Optic neuritis
* CRAO
Orbital complications
* Subperiosteal abscess
* Orbital abscess
Temporal/parotid abscess
*d/t spread of infection
around the orbit
Intracranial complications
* Carvenous sinus
thrombosis
* Meningitis
* Brain abscess
General
septicemia/pyaemia

8. • Collection of purulent material between the
orbit bony wall & periosteum
• Suspected when associated with eccenteric
proptosis
• Confirm by CT scan
Subperiosteal
abscess
• Collection of pus within orbital tissue
• Suspected by signs of severe proptosis,
marked chemosis, complete
ophthalmoplegia & pus point below
conjunctiva
• Confirm by CT scan
Orbital
abscess

9. INVESTIGATIONS
 Bacterial cultures
 From nasal and conjunctival swabs and blood samples
 Complete haemogram
 May reveal leukocytosis
 X-ray PNS
 Identify associated sinusitis
 Orbital ultrasonography
 Detect intraorbital abscess
 CT scan & MRI
 Differentiating preseptal & postseptal cellulitis
 Detect subperiosteal abscess
 Orbital abscess
 Intracranial extension
 Deciding when & where to drain orbital abscess

10. TREATMENT
 Orbital cellulitis is an emergency!
 Hospitalised the patient for aggressive management
1. Intensive antibiotic therapy
• Staph infections: high doses of
penicillinase-resistant
antibiotics+ampicillin
• Alternative: cefotaxime,
ciprofloxacin, vancomycin
• H. influenzae : chloramphenicol /
clavulanic acid
• Anaerobes : oral metronidazole
500mg every 8 hours
2. Analgesic & anti-inflammatory
drugs
• control pain and fever
3. Topical antibiotic eye ointment
• QID, for corneal exposure and
chemosis (severe proptosis)
4. Start nasal decongestant drops
5. Revaluation
• 2-3 times/day
• to monitor the response and modify
the Rx accordingly

11. Surgical intervention
 Indications:
 Unresponsiveness to antibiotics
 Decrease vision
 Presence of an orbital/subperiosteal abscess
 Immediate canthotomy / cantholysis
 If the orbit is tight, presence of optic neuropathy, IOP severely
elevated.
 Free incision into the abscess
 When presence under skin or conjunctiva.
 Drainage of pus
 For subperiosteal abscess : 2-3 cm curved incision in upper medial
aspect.
 Drain both orbit and infected paranasal sinuses.