Bilateral is Bad! Think Cavernous Sinus Thrombosis!!
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.
Patients tend to present with a rapid development of symptoms. Periorbital cellulitis tends to present with swelling of eyelids and skin erythema or discoloration. Fever, conjunctival injection and associated discharge may be present; however, visual acuity, movements and pupillary response will be normal. Orbital cellulitis has similar, but more severe symptoms, often including proptosis, ocular pain, raised intraocular pressure, painful and restricted movements, and reduced or complete loss of trigeminal nerve sensation.
The single most important imaging investigation in orbital cellulitis with suspected orbital abscess is a CT scan, as this would aid in the detection and demarcation of the abscess and assessment of the sinuses. However, this may not be possible in resource-poor environments. Ocular ultrasonography is also useful in cases of orbital abscess, and plain sinus X-rays may show air-fluid level in the sinuses.
If the infection moves past the septum, into the orbital fat or the extraocular muscles that move the eye, it becomes a medical emergency, an orbital cellulitis, also called a septal cellulitis.
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.
Periorbital cellulitis is the umbrella term used to describe a group of conditions ranging from pre‐septal cellulitis to cavernous sinus thrombosis using the modified Chandler's classification. Pre‐septal cellulitis is the most common manifestation of periorbital cellulitis.
Periorbital cellulitis often occurs from a scratch or insect bite around the eye that leads to infection of the skin. Symptoms can include swelling, redness, pain, and tenderness to touch occurring around one eye only. The affected person is able to move the eye in all directions without pain, but there can be difficulty opening the eyelid, often due to swelling. Vision is normal.
Nowhere is there a greater discrepancy between paediatricians and ophthalmologists than in differentiating between periorbital and orbital cellulitis in children. The former tends to be overdiagnosed while the latter is often undertreated.
Differentiating orbital from preseptal cellulitis is extraordinarily important given that orbital cellulitis has the potential to cause a compartment syndrome within the eye socket resulting in irreversible vision loss to the affected eye.
Some medical conditions have signs and symptoms that significantly overlap, making a diagnosis a little more difficult. Epididymitis, testicular torsion, and torsion of the testicular appendage are examples, but orbital and preseptal cellulitis are others that can cause significant diagnostic confusion.
Orbital cellulitis management guideline – For Adults & Paeds.
The diagnosis of orbital cellulitis is based on clinical examination. The presence of the following signs is suggestive of orbital involvement: proptosis, chemosis, pain with eye movements, ophthalmoplegia, optic nerve involvement as well as fever, leukocytosis (75% of cases), and lethargy.
Ophthalmic signs most frequently seen with orbital cellulitis are limited ocular motility, proptosis, chemosis, and conjunctival hyperemia.
Orbital cellulitis is defined as a serious infection that involves the muscle and fat located within the orbit. It is also sometimes referred to as postseptal cellulitis. Orbital cellulitis does not involve the globe itself. Although orbital cellulitis can occur at any age, it is more common in the pediatric population.The causative organisms of orbital cellulitis are commonly bacterial but can also be polymicrobial, often including aerobic and anaerobic bacteria and even fungal or mycobacteria