Basic and patient-oriented research
The Acute Orbit: Etiology, Diagnosis, and Therapy

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Purpose

Extension of dental abscesses to distant areas of the head and neck has been repeatedly reported in the medical literature. Subsequent involvement of the orbit still remains a rarity, resulting in protracted onset of therapy because of inaccurate diagnosis. Considering the possible lasting damage that can result from insufficient therapy, like blindness or even death, the need to extensively educate practicing physicians becomes evident.

Materials and Methods

With the help of a comprehensive review of the medical literature underlined with a clinical case, the etiology, diagnosis, and therapy of the acute orbit are highlighted with emphasis on the new imaging modalities as well as the broad spectrum antibiotics currently available on the market.

Results

Orbital infections of odontogenic origin are the rarest sequelae, with a prevalence of 1.3%. Correct diagnosis, adequate antibiotic therapy, and surgical drainage are the keys to success.

Conclusion

The acute orbit continues to be a medical challenge. With the proposed diagnostic and therapy guidelines, this affliction can be identified and contained with a high degree of certainty.

Section snippets

Anatomy and Classification

Although it is the rarest infectious entity of the maxillofacial region,10 or rather because it is so rare, special attention must be paid to this infectious sequelae (Fig 1). Infectious afflictions of the orbit can have their origin in numerous sources. Emanating from the eye or surrounding tissue, it can also be the result of an infectious spread from neighboring structures. The dire consequences of such an infection, if treatment is not implemented, can be impairment of visual acuity or

Etiology and Bacteriologic Profile

In reviewing the literature, it becomes evident that paranasal sinusitis is predominantly responsible for the transduction of infection toward the orbit,2, 8, 13, 18, 19 mainly seen in children.20, 21 Moloney et al22 report an incidence of 60%, whereas O’Ryan et al23 estimated it to occur in 84% of cases. On the other hand, only 1% to 2% of all paranasal sinusitis leads to orbital involvement,24 a reflection of the relatively high incidence of sinusitis in the general population. Mills and

Symptoms and Diagnosis

Correct interpretation of the clinical symptoms is important to ensure expedient therapy (Fig 2). Only the physician, who can deduce that an orbital abscess is present, will also realize the importance of quick action, avoiding at best the detrimental sequelae of a fulminate course, which could lead at worse to blindness or death.

Depending on the manifestation of the infection, we can differentiate between the following symptoms:

  • 1)

    Preseptal infection: with swelling of the eyelids and erythema.

  • 2)

Therapy

The management of periorbital and intraorbital infections must still be considered surgical emergencies.33 The necessary therapy stands on 3 pillars:

  • 1)

    Surgical incision and drainage of the subperiosteal or intraorbital abscess.

  • 2)

    Antibiotic therapy, initially intravenously.

  • 3)

    Eradication of the primary source, ie, revision of the paranasal sinuses and extraction of decayed teeth or other osseous infections.

The surgical therapy should be performed under general anesthesia to ensure meticulous

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      The anterior portion of the orbit is narrower than the area behind the rim, which adds protection [4–7]. The orbit lies in close proximity to the paranasal sinuses (Fig. 1), allowing sinus infections to spread to the periorbital tissues (preseptal cellulitis) and into the orbit itself (orbital cellulitis) [8]. These conditions will be discussed in detail in an article by Mueller and McStay elsewhere in this issue.

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