ORBITAL CELLULITIS

Defination: Orbital Infection behind orbital septum

clinical features:

• lid edema

• chemosis

• reduced visual acuity

• painful proptosis, 

• ophthalmoplegia, 

• and relative afferent pupillary defect

• fever and cerebral signs due to neurological involvement

• It is serous serious sight and life threatening condition.

investigation

• Ascertainment of tetanus immunization status in cases of trauma.

• White cell count.

• Blood cultures.

• Culture of nasal discharge.

• High-resolution CT of the orbit, sinuses and brain

Treatment involves 

• hospitalization, 

• ENT and pediatric evaluation

• intravensous antibiotics including ceftazidime and metronidazole. 

• optic nerve function tests: severe optic nerve compression need emergency canthotomy/ cantholysis

• orbital debulking in non responsive cases

• drainage of subperiosteal abscess

complications

The infection can spread to brain. 

• optic neuropathy'

• exposure keratopathy

• raised intraocular pressure

• endophthalmitis

• subperiosteal abscess most commonly along medial orbital valve

• CRAO

• CRVO

• meningitis

• cerabral abscess

• cavernous sinus thrombosis

DD of acutely inflammed orbit

• infections as

  • orbital cellulitis

  • fungal orbital infection

• vascular lesions

  • acute orbital hemorrhage

  • cavernous sinus thrombosis

  • carotid cavernous fistula

• neoplasia

  • retinoblastoma

  • lacrimal gland tumors

  • rhabdomyosarcoma

  • leukomia

  • lymphoma

• endocrine 

  • thyroid eye disease

• non-neoplastic inflammatory diseases

  • idiopathic orbital inflammatory disease

  • orbital mysositis