Orbital Abscess With Unusual Features

Journal of Ophthalmic Inflammation and Infection

Background: Orbital cellulitis is an ophthalmic emergency, which is associated with vision-threatening adverse effects. The purpose of this study is investigating etiology, radiologic findings, management and complications of patients with non-medial orbital cellulitis. Method: A retrospective medical record and radiologic file review of patients with infectious orbital cellulitis was performed to detect all patients with non-medial orbital cellulitis who referred to Khalili hospital from 2016 to 2019. Age, sex, origin of infection, size of collection or abscess, medical or surgical management, microbiology, first and final best-corrected visual acuity, duration of admission, and complications was recorded. Patients divided into two groups; medical management and surgical management groups and all of data compared between in this groups. Results: Of ninety-six patients with infectious orbital cellulitis, 23 cases (14 male, 9 female) were included. Five patients (21.7%) were managed medically and 18 patients (78.3%) were managed surgically. Patients' age range was 5-70 years old. Most common location for non-medial cellulitis was superior space (66.7% in surgical and 40% in medical group; p = 0.511). In 13 cases of surgical group (72.3%) were detected microorganisms. The mean ± SD of collection volume in medical group were 476.5 ± 290.93 mm 3 and 2572.94 ± 1075.75 mm 3 in surgical group (p < 0.001). Ten patients in surgical group had compressive optic neuropathy. The mean ± SD of collection volume was 3204.97 ± 879.88 mm 3 in patient with compressive optic neuropathy and 1280.43 ± 880.68 mm 3 in patient without compressive optic neuropathy (P < 0.001). One case complicated by subdural empyema and another case progressed to necrotizing fasciitis. Conclusion: Non-medial orbital cellulitis is an uncommon but sight-threatening and life-threatening condition. Timely diagnosis and accurate management reduce morbidity and mortality. Combined surgery for patients with superior or supra-temporal and large non-medial abscess is recommended.

Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2000

Twenty patients with orbital cellulitis were treated over a seven-year period. All patients had a CT scan for localization and categorization of the disease. Fourteen of sixteen patients with post-septal involvement underwent surgical drainage and orbital exploration via an external ethmoidectomy approach. Two of these fourteen patients also had an optic nerve decompression. Clinical signs were found to be accurate in differentiating pre-septal from post-septal cellulitis tut were inadequate for further categorization of the type of post-septal cellulitis. All ten patients with pre-septal cellulitis or a post-septal subperiosteal abscess recovered with preservation of vision. Mild to moderate degrees of visual loss could be reversed with emergent surgical treatment even after 10 days from the onset of visual loss. Post-septal intraperiosteal orbital cellulitis and orbital abscess however resulted in significant permanent visual disability in eight of ten cases.

Ophthalmology Journal

BaCkground: Orbital cellulitis is an infectious involvement of the tissues posterior to the orbital septum causing severe local and general complications. Material and Methods: The aim of our work was to study the clinical, paraclinical and therapeutic characteristics of orbital cellulitis through a retrospective study of 89 cases collected between 2015 and 2019. The diagnosis of orbital cellulitis was based on clinical and imaging elements. results: The average age was 17.5 years. Exophthalmos was noted in 33% of cases, ophthalmoplegia in 18% of cases, diplopia in 4.5% of cases and ocular hypertonia in 11% of cases. Orbital CT scan allowed the diagnosis of subperiosteal abscess in 20% of cases and orbital abscess in 10% of cases. Sinusitis was the main infectious origin in children, while dacryocystitis predominated in adults. All patients received parenteral antibiotherapy combined with corticotherapy after 48 hours. Complications occurred in 10 cases, dominated by exposure keratitis, panophthalmitis and optic atrophy with permanent blindness. ConClusions: We emphasize the importance of rapid diagnosis and urgent treatment of orbital cellulitis.

Survey of Ophthalmology, 2008

A 52-year-old, immune-suppressed man presented with painful proptosis. Orbital imaging revealed enhancement of his right inferior rectus muscle and mild ethmoidal sinus disease. Sinus washings and turbinectomy demonstrated Curvularia. Despite aggressive intravenous antimicrobials, the patient remained febrile. Repeat imaging demonstrated a well-defined intramuscular abscess without contiguous orbital or paranasal involvement. Following surgical drainage, the patient improved. Cultures of the material expressed from the abscess confirmed a co-infection with Fusarium. Although rare, fungal abscess of the extraocular muscle should be considered in patients (particularly if immunosuppressed) with extraocular muscle enlargement resistant to conventional antimicrobial therapy. Prompt diagnosis and treatment could potentially prevent further serious morbidity or mortality.

Journal of Clinical Ophthalmology

Purpose: The purpose is to report a case of left orbital cysticercosis, presented with signs of acute preseptal cellulitis. Case report: Orbital infection is a form of inflammation caused by infective agents and, therefore, orbital infection and other orbital inflammatory processes can have similar presentation. Parasitic infestations of the orbit are rare, commonly located in the superolateral and superomedial angles of the orbit. We report a case of 31 year old man who presented with acute painful rapidly progressive periocular swelling, didn't show any response to 1 week of systemic antibiotics. Left orbital cyst excision was done after correlating with radiological findings and histopathological features were suggestive of parasitic infected cyst. Conclusion: Parasitic infected cyst could be considered in the differential diagnosis of unilateral periocular swelling with proptosis, commonly in superior part.

Journal of Ophthalmic and Vision Research, 2018

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.

International Journal of Pediatric Otorhinolaryngology, 2017

Objective: Pediatric periorbital cellulitis represents a common disease complicating a nasal infection. Methods: A ten-year retrospective review of fifty-seven children admitted to our institution with the diagnosis of periorbital cellulitis as a complication of sinus infections was carried out. Results: The age varied from one month to eleven years (mean 3.9 years). Thirty-five were males (62%), while twenty-two were females (38%). Nine out of fifty-seven (15.8%) presented exophthalmos associated with eyelid erythema and edema, while the rest suffered mainly from eyelid erythema and edema. Twenty-two patients complaining of exophthalmos or not responding to medical therapy within 48 hours were assessed with a computed tomography scan (38.6%). A subperiosteal orbital abscess was detected in nine cases and these patients underwent surgical drainage (15,8%). Recurrence of orbital infection occurred in three cases (5.3%). Conclusions: Medical management is the main treatment for both preseptal and postseptal orbital cellulitis. Nevertheless, there is no universally accepted guideline for the treatment of subperiosteal abscesses and each case should be treated accordingly. Urgent surgical drainage should be considered in cases not responding to adequate medical management, or those cases presenting visual deterioration.

2018

Orbital cellulites is an uncommon infectious process in which patient may present with pain, reduced visual acuity, compromised ocular motility and significant proptosis. [1][3] In the modern era of relatively early access to the health care facilities, complete loss of vi‐ sion from orbital cellulitis is rare. In the vast majority of cases, a history of upper respirato‐ ry tract infection prior to the onset is very common especially in children. [4], [5] Chandler et al, [6] for simplicity has classified the disease into 5 categories and emphasized the pos‐ sibility of fatal outcome due to the extension of the abscess to cavernous sinus in the form of thrombosis and intracranial spread. In addition to the loss of vision, orbital cellulitis can be associated with a number of other serious complications that may include intracranial complications in the form of cavernous sinus thrombosis, meningitis, frontal abscess and even death. Historically, since the wide spread use of effective ...

SAGE open medical case reports, 2018

Nasal septal abscess is a rather unusual condition encountered in the Otorhinolaryngology outpatient department, let alone it being a complication of orbital cellulitis! The condition usually occurs due to trauma which is significant enough to cause a septal haematoma. The haematoma then eventually results in formation of a localised abscess. Orbital cellulitis as a sequela of nasal septal abscess is an established complication but vice versa, septal abscess as a sequela of orbital cellulitis is an extremely rare presentation. To emphasise the possibility of anterograde as well as retrograde passage of infection via valveless veins in the face, we report a unique case of a 2-month-old infant who developed nasal septal abscess as a complication of orbital cellulitis.

IP Innovative Publication Pvt. Ltd., 2019

Introduction: Infection in the orbit and the periorbital tissues are particularly important subsets of inflammatory diseases not only because of frequency of presentation but also because of life threatening conditions which demand prompt, specific and therapeutic management. Of the orbital inflammation with infections most common aetiological factors encountered, are due to bacteria. Materials and Methods: All patients with orbital signs and symptoms of inflammatory diseases of infectious origin were selected. Progression, symptoms, history of associated symptoms such as headache, fever, allergy etc. asked for. History of trauma, immunization and systemic illness, endocrinological disorders, infections of any systems and any dermatological disorders were taken into account. Local examination, ENT examination, laboratory and radiological investigations were done in all cases. Results: Incidence of orbital infection is 0.34%. Male preponderance and maximum number of patients were adult. The maximum aetiological factor of orbital infection being due to infections of the ocular adnexae, sinusitis, dacryocystitis, post-surgical, and trauma. Raised IOP in 24%, proptosis in 34%, restricted ocular motility in 42%, mechanical ptosis in 70%, NLD block in 18%, Corneal oedema or opacity in 14% and inflammation of ocular adnexae in almost all cases. In majority of the cases the organism responsible is Pseudomonas aeuroginosa, then staphylococcus aureus. Conclusion: Orbital infection is sight threatening and the pathognomic features and virulence of the causative organism is unpredictable. Early presentation appropriate diagnosis and judicious protocol if followed at an early stage would halt the morbidity and fatality. Keywords: Clinicopathology, Infectious origin, Orbital cellulitis, Orbital inflammation, Preseptal cellulitis

Common Eye Infections, 2013

A 55-year-old albanian male was referred to the Ophtalmology Department in Mother Theresa University Hospital Tirana, with blurried vision, painful proptosis, limitied eye movements diplopia and chemosis of the right eye for three days. Two years ago he was diagnosed with orbital cellulitis. Over the next 72 hours, he did not clinically improve as it was expected. a diffuse infiltrative mass of orbital muscles and fat on the right eye with exophtalmy of this side that suggested for infiltrative tumor. Based on the results of radiology, it was required biopsy. Histopathology revealed the presence of lymphocites, plasma cells, myofibrolastic cells and collagen, with diagnose of inflammatory chronic moderated lesion. Given the negative workup, the presentation was determined to be consistent with idiopathic orbital inflammation via a diagnosis of exclusion. Therefore, the patient was treated with intravenous steroids that produced pronounced improvement within 24 hours. The patient was discharged in improved condition with a prednisone taper and ophtalomoly follow-up. Orbital pseudotumor if often misdiagnosed as orbital cellulitis, because of the similar presentation. It is important to consider differential diagnose when the initial diagnose and treatment does not progress as we expect.

Arquivos Brasileiros de Oftalmologia, 2008

Journal of Evolution of Medical and Dental Sciences, 2016

BACKGROUND Pre-septal 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. The aim of this paper is to describe the clinical profile of cases with pre-septal and orbital cellulitis admitted to Santhiram Medical College, Nandyal and analysis of clinical outcome.

British Journal of Ophthalmology, 1989

We studied a total of 23 patients with orbital cellulitis and/or orbital abscess over a period of four years in Saudi Arabia. The study showed a high rate of abscess formation (12/23) and surgical intervention (17/23). Twelve out of 23 patients were 18 or more years of age. Furthermore, 12 of 23 (52%) patients had blind eyes on admission and remained blind after treatment, and one patient died of cavernous sinus thrombosis. Only 7/23 (30%) had a predisposing cause of primary sinus disease. This study of orbital cellulitis in a developing country presents a variation in disease pattern from previous reports and suggests that delay in the initiation of antibiotic therapy may lead to serious complications which may be life threatening. The course and outcome of orbital cellulitis may vary, depending on the predisposing factor, time of onset, associated systemic disease, or delay in initiation of treatment.