Orbital Cellulitis

ORBITAL CELLULITIS

Orbital cellulitis is inflammation of the tissues surrounding the eye and may result from bacterial, fungal, or viral inflammatory conditions of contiguous structures, such as the face, oropharynx, dental structures, or intracranial structures. It can also result fromforeign bodies and from a preexisting ocular infection, such as dacryocystitis and panophthalmitis, or from generalized sep-ticemia. Infection of the sinuses is the most frequent cause. In-fection originating in the sinuses can spread easily to the orbit through the thin bony walls and foramina or by means of the in-terconnecting venous system of the orbit and sinuses. The most common causative organisms are staphylococci and streptococci in adults and H. influenzae in children.

The severe intraorbital tension caused by abscess formation and the impairment of optic nerve function in orbital cellulitis can result in permanent visual loss. Because of the orbit’s prox-imity to the brain, orbital cellulitis can lead to life-threatening complications, such as intracranial abscess and cavernous sinus thrombosis.

Management

Immediate administration of high-dose, broad-spectrum, sys-temic antibiotics is indicated. Cultures and Gram-stained smears are obtained. Monitoring changes in visual acuity, degree of proptosis, central nervous system function (eg, nausea, vomiting, fever, level of consciousness), displacement of the globe, extra-ocular movements, pupillary signs, and the fundus is extremely important. Consultation with an otolaryngologist is necessary, especially when sinusitis is suspected. In the event of abscess for-mation or progressive loss of vision, surgical drainage of the ab-scess or sinus is performed. Sinusotomy and antibiotic irrigation are also performed.