Orbital Cavity 1551 Orbital Cellulitis Definition

Acute inflammation of the contents of the orbital cavity with the cardinal symptoms of limited motility and general malaise.

H Orbital cellulitis is the most frequent cause of exophthalmos in children.

Etiology: Acute orbital inflammation posterior to the orbital septum is usually an inflammation that has spread from surrounding tissue. Over 60% of all cases (as high as 84% in children) may be classified as originating in the sinuses, especially the ethmoidal air cells and the frontal sinus. In infants, tooth germ inflammations may be the cause. Less frequently, this clinical picture occurs in association with facial furuncles, erysipelas, hordeolum, panophthalmitis, orbital injuries, and sepsis.

Symptoms: Patients report severe malaise, occasionally accompanied by fever and pain exacerbated by eye movement.

Diagnostic considerations: Typical symptoms include exophthalmos with severe chemosis (conjunctival swelling), eyelid swelling, and significantly limited ocular motility ("cemented" globe; see Fig. 15.5). Patients may exhibit leukocytosis and an increased erythrocyte sedimentation rate.

Where there is clinical evidence of suspected involvement of the paranasal sinuses, an ENT specialist should be consulted to evaluate the sinuses and initiate any necessary treatment.

— Patient with orbital cellulitis.

— Patient with orbital cellulitis.

Fig. 15.5 Typical symptoms include chemosis (conjunctival swelling), exoph-thalmos, and significantly limited ocular motility (the right eye does not move with the left eye).

Differential diagnosis: Preseptal cellulitis, which is more frequently encountered, should be excluded. The inflammation in preseptal cellulitis is anterior to the orbital septum; chemosis and limited motility are absent. Rarer clinical syndromes that should also be considered in a differential diagnosis include an orbital pseudotumor, orbital periostitis which may be accompanied by a subperiosteal abscess, and an orbital abscess.

H The crucial characteristic feature of orbital cellulitis for differential diagnosis is the significantly limited ocular motility ("cemented" globe). A rhabdomyosarcoma should also be considered in children.

Treatment: This consists of high-dose intravenous antibiotic therapy with 1.5 g of oxacillin every four hours combined with one million units of penicillin G every four hours. Infants are treated with ceftriaxone and school-age children with oxacillin combined with cefuroxime in the appropriate doses. Treatment of underlying sinusitis is indicated in applicable cases.

Clinical course and complications: Orbital inflammation can lead to optic neuritis with subsequent atrophy and loss of vision. Purulent thrombophlebitis of the orbital veins can result in cavernous sinus thrombosis with meningitis, cerebral abscess, or sepsis.

Orbital cellulitis can progress to a life-threatening situation (cavernous sinus thrombosis).

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