Basic and patient-oriented researchThe Acute Orbit: Etiology, Diagnosis, and Therapy
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.
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Antibiotic therapy, initially intravenously.
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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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Cited by (26)
A case of orbital cellulitis due to bacteremia caused by oral Streptococcus pyogenes
2024, Journal of Oral and Maxillofacial Surgery, Medicine, and PathologySomething in your eye: Periorbital cellulitis
2021, Pediatric Imaging for the Emergency ProviderThe Physical Examination of the Eye
2008, Emergency Medicine Clinics of North AmericaCitation Excerpt :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.
Imaging Studies for Head and Neck Infections
2007, Infectious Disease Clinics of North AmericaCitation Excerpt :Orbital infection most often is secondary to spread from an adjacent sinusitis, where it complicates 3% of cases. Other sources are skin/conjunctiva or hematogenous seeding, with an odontogenic origin being rare [44]. Most patients have clinically apparent periorbital cellulitis, and the role of imaging is to evaluate the degree of orbital or retroorbital involvement.
Complicated periorbital cellulitis: Case report and literature review
2012, Journal of Laryngology and Otology