Case Of Orbital Cellulitis Research Articles

Trends in orbital cellulitis severity and management: 2016 through 2022

ABSTRACT Purpose To characterize trends in orbital cellulitis (OC) severity and management from 2016 through 2022, including assessment of effects from the COVID-19 pandemic. Methods A retrospective chart review was conducted at a tertiary care center using an electronic medical record search of OC from January 1 2016 to January 1 2023. Radiography was used to categorize patients into three cohorts – OC without abscess, OC with subperiosteal abscess (SPA), and OC with orbital abscess (OA). Infection cohort and age group [pediatric (<9 years old), adolescent (9–18 years), adult (>18 years)] were compared across years. Subgroup analysis was performed in the SPA cohort. Comparisons were made between the time periods prior to and after the start of the COVID-19 pandemic. Results From 2016–2022, there were 247 (67.3%) cases of OC, 103 (28.1%) SPA, and 17 (4.6%) OA. The year 2022 incurred higher rates of SPA and OA (p = 0.035), pediatric infections (p = 0.008), and co-morbid sinusitis (p = 0.005) compared to all preceding years. Rates were similar from 2016 through 2021. Within the SPA cohort, rates of surgical intervention and outcomes were similar across all years. Rate of abscess formation was significantly higher during the COVID-19 pandemic compared to the pre-pandemic era (p = 0.033). Conclusion The severity of OC leading up to the COVID-19 pandemic appeared steady. After pandemic onset, a delayed increase in abscess formation, predominantly affecting pediatric patients and correlating with a greater rate of sinusitis, was observed in 2022.

Management of periorbital cellulitis at the Pediatric Emergency Department: A ten years study

The goal of this study was to analyze the epidemiological and therapeutic features and outcomes of periorbital cellulitis cases treated in the pediatric emergency department. A retrospective study including all the children aged between 1 month and 15 years treated for periorbital cellulitis in the Pediatric Emergency Department of the Mohamed VI University Teaching Hospital in Marrakech over a period of 10 years (January 1, 2010-December 31, 2019). In all, 168 cases of periorbital cellulitis were recorded, with an increasing of the number of cases, from 2 in 2010 to 39 in 2019. The most affected age bracket was the group under 5 years of age (62.5%). The most frequent mode of entry was sinusitis (22%). Preseptal cellulitis was most common (76.7%). The main clinical signs found in orbital cellulitis were proptosis (64%) and chemosis (35.8%), versus conjunctival hyperemia (78%) in preseptal cellulitis. Ophthalmoplegia was present in two cases of orbital cellulitis. The right side was most affected (44%). An orbital CT scan was performed in all cases in our study, showing preseptal cellulitis in 129 patients (76.7%), orbital cellulitis in 14 cases (8.3%), subperiosteal abscess in 20 cases (12%) and orbital abscess in 5 cases (3%). Prior treatment with non-steroidal anti-inflammatory medication was noted in 6%. The most commonly used antibiotic was amoxicillin-clavulanic acid. Steroid treatment was prescribed in 6% of cases. Surgical treatment was indicated in 12 patients(7.1%). The mean hospital length of stay was 3 days for the preseptal cases and 8 days for the orbital cases. All patients had good outcomes with medical and/or surgical treatment. With follow-up of over one year, no complications were noted. The majority of our cases had positive outcomes, highlighting the advantage of early diagnosis, adapted antibiotic treatment and multidisciplinary care, rendering surgery rarely necessary.

Orbital cellulitis secondary to sinusitis in upstate New York: current incidence, seasonality, severity, management and outcomes

ABSTRACT Purpose While sinusitis carries a seasonal variation, the temporal features of sinusitis-related orbital cellulitis (SRC) are unclear. This study analyzes the incidence, seasonality, management, and outcomes of SRC in northeastern New York. Methods A retrospective review of 79 patients was performed from January 2008 – December 2018. Cases of orbital cellulitis without comitant sinusitis were excluded. Demographic, radiographic, clinical features, month at presentation, interventions (surgical and nonsurgical), microbiology, and hospitalization duration were recorded. Fisher-exact test, Mann–Whitney test, and Kruskal Wallis test statistical analyses were performed in consultation with our institution’s statistician via a dedicated software package (vassarstats.net). Results 79 patients were admitted for SRC. 25 patients were treated with antibiotics only, 31 underwent orbitotomy exclusively and 23 received combined orbitotomy and functional endoscopic sinus surgery (FESS). Of the 31 patients who underwent orbitotomy only, 8 (26%) returned to the operating room. In contrast, of those who underwent concomitant orbitotomy and FESS, only one patient (4.3%) required re-operation (fisher exact test, p = .021). The median length of stay for the antibiotic-only group (4 days), orbitotomy-only group (6 days), and combined surgery group (5 days) were statistically different (Kruskal Wallis, p = .004, Figure 3). Interestingly, there was no significant relationship of incidence or severity of SRC related to seasonality (fisher-exact test, p = .76). Conclusion Our findings suggest that cases requiring surgical management for SRC should undergo coinitial orbitotomy with FESS to reduce re-operation rates. Additionally, SRC incidence and severity did not correlate with season.

Orbital cellulitis as a complication of odontogenic infection

Orbital cellulitis is uncommon sequelae of the spread of odontogenic infection to adjacent maxillary sinuses or to distant sites such as the orbits. Once it happened, the spread of such infection can be of serious complication such as complete blindness or even more serious and life threatening situations as cavernous sinus thrombosis, intra-cranial abscess, or even death. This paper aimed to expose the guideline treatment of orbital cellulitis as a complication of odontogenic infection. It reported one case of orbital cellulitis in the emergency unit of Hasan Sadikin hospital Bandung, with complaints of pain, swelling at cheek and periorbital region, and the history of toothache. The treatment include incision drainage, extraction of tooth, and parenteral administration of antibiotic and analgesic. Odontogenic infections are derived from dental infection and can potentially spread rapidly to be ascending infection like orbital cellulitis. Odontogenic infection and orbital cellulitis should be adequately treated with incision drainage, extraction of tooth and parenteral administration of antibiotic, steroid and analgesic. Without immediate treatment, odontogenic infection can lead to ascending infection. Orbital cellulitis due to spreading of odontogenic infection is a rare case. In this case report, the patient had a significantimprovement due to immediate and proper treatment.

Orbital cellulitis following Caldwell Luc procedure for maxillary sinusitis leading to a rare complication of central retinal artery occlusion

Posterior orbital cellulitis is a clinical syndrome in which early severe visual loss overshadows or precedes accompanying inflammatory orbital signs. It is an ocular emergency that can threaten life and vision. Central retinal artery occlusion (CRAO) is a very rare condition leading to sudden onset of decreased vision and can even progress to blindness. We report a case of orbital cellulitis following Caldwell Luc surgery in a middle-aged diabetic woman, resulting in the rare complication of CRAO, leading to blindness in her right eye. The development of retinal artery occlusion after orbital cellulitis has not been well documented in literature. A quick diagnosis and close monitoring following sinus surgery is therefore needed to prevent such rare complications to happen.

Orbital complications of pediatric rhinosinusitis: A single institution report.

Rhinosinusitis is one of the most common infections of childhood. Rhinosinusitis usually limits itself in the pediatric age group, however orbital and intracranial complications may arise in some of the patients. The purpose of the study was to retrospectively analyse the previous treatments and outcomes in pediatric rhinosinusitis patients with orbital complications. The effect and prognosis of medical treatment and endoscopic sinus surgery are reported in this study. Twenty-five pediatric patients diagnosed with complicated rhinosinusitis between January 2008 - February 2016 were included in the study. Orbital complications, examination findings, radiological imaging and blood counts were retrospectively collected from patient files. The duration of hospitalization, source of the infection, complications, previous medical and surgical treatments were also retrospectively assessed. Average age of the patients were 8.84 ± 4.02 years (range: 1-16 years). The mean length of stay in hospital was 6.72 ± 3.28 days. Hospitalization in surgically treated group was higher than primarily medically treated group. However this difference could not reach to a statistically significant level (p > 0.05). Mean hospitalization time was found 5.21 ± 2.51 and 8.43 ± 2.87 days in patients diagnosed with preseptal cellulitis and subperiosteal abscess respectively. Hospitalization in patients with subperiosteal abscess was higher than preseptal cellulitis and a statistically significant difference was detected (p < 0.05). Morbidity and mortality of orbital complications which are the most common complications of pediatric rhinosinusitis, could significantly be reduced by using appropriate treatment methods and an early diagnosis. Conservative therapy is an effective method for patients with preseptal cellulitis and most cases of orbital cellulitis in children.

A Case of bacterial orbital cellulitis with complete ophthalmoplegia

Orbital cellulitis (OC) refers to acute infection of soft tissues of the orbit behind orbital septum. As many as 11% cases of OC result in visual loss. Here, we report a 60-year-old female who is a known case of Type 2 diabetes mellitus presented with complaints of right-sided headache, unable to open right eyelid, and unable to move eyeball for 1 month. Magnetic resonance imaging brain with orbit contrast done showed right-sided OC with forming abscess. Nasal endoscopy was done and nasal swab culture showed growth of Staphylococcus aureus. The patient was kept on antibiotics and was discharged after improvement. Prompt diagnosis and proper management are essential for curing the patient with OC. This is particularly important to prevent visual loss and other severe life-threatening complications.

A Case of Pseudomonas Orbital Cellulitis Following Glaucoma Device Implantation

Orbital cellulitis is a rare complication of aqueous tube shunt surgery. Nine cases have been described in the literature, though the microbiologic etiology is rarely reported. Management with intravenous antibiotics and/or explantation has been described. This is a case report and literature review. A 64-year-old woman developed pain, periorbital swelling, limited extraocular motility, proptosis, and conjunctival injection 3 days following implantation of an Ahmed Glaucoma Valve. Computed tomography of the orbits with contrast showed soft tissue fat stranding consistent with orbital inflammation. Initial medical management with topical and intravenous ceftriaxone and vancomycin was unsuccessful. Surgical removal of the implant was performed and intraoperative cultures demonstrated florid Pseudomonas aeruginosa growth. Antibiotic coverage was changed to Piperacillin-Tazobactam for 3 days, with eventual resolution of her orbital symptoms. We report the first case of orbital cellulitis after implantation of a glaucoma device associated with P. aeruginosa. Failure of intravenous and topical antibiotics led to explantation of the valve and targeted intravenous antibiotic therapy with subsequent clinical improvement.

Orbital Cellulitis with Unilateral Rhinosinusitis in Adult

&#x0D; &#x0D; &#x0D; Background : Orbital cellulitis is one of complication from rhinosinusitis. Although the prevalence in adult is less common than in children, the morbidity is higher. An appropriate treatment for this case should be given to avoid morbidity. Method : Serial cases of orbital cellulitis with unilateral sinusitis in Adult were reported in Dr.CiptoMangunkusumo Hospital. All cases occurred from December 2017-May 2018. &#x0D; Result : There were 4 cases reported. Range 26-57 years old. All cases had eyelid swelling, two cases had limitation eye movement, and two cases had visual deterioration. Ethmoid sinus was the most common sinus affected. All cases were treated with broad-spectrum antibiotic and metronidazole. Orbital decompression was performed in two cases. &#x0D; Conclusion: Appropriate treatments such as the use of systemic antibiotic and surgical is needed to decrease the morbidity. &#x0D; &#x0D; &#x0D;

Intra-ocular medulloepithelioma as a masquerade for PHPV and Panophthalmitis: a Diagnostic Dilemma

A previously diagnosed child of persistent hyperplastic primary vitreous (PHPV) with painless blind eye remained clinically silent for about 3years follow-up. The child suddenly presented as a case of orbital cellulitis and panopthalmitis with meningitis. No definite mass lesion was detected on ultrasonography, magnetic resonance imaging (MRI) and positron emission tomography (PET) scan. Histopathology of the enucleated eye revealed intra-ocular medulloepithelioma as the culprit of sterile panophthalmitis and orbital inflammation.

Orbital cellulitis in Ibadan, South-western Nigeria: A 7-year prospective study

Objective: Orbital cellulitis is an infection of the soft tissues behind the orbital septum. This study aims to determine the presentation, management and outcome of cases of orbital cellulitis managed at a tertiary health facility in Ibadan, South-Western Nigeria. Materials and Methods: Prospective study of all cases of orbital cellulitis managed during a 7-year period was conducted. The patients’ demographics, clinical findings, management, outcome of treatment and complications were analyzed. Results: Sixty-three patients were managed during the period with mean age of 20.3 ± 20.1 years, and average duration of symptoms 7.9 days (Interquartile range, 4 days). The right eye was affected in 30 (47.6%) patients, while four (6.3%) patients had bilateral involvement. There was history of trauma in 19 (30.2%) patients whereas 13 (20.6%) patients had paranasal sinus infection. The corrected visual acuity at presentation was >6/18 in 30 (44.8%) eyes and 6/18 in 31 (46.3%) eyes and

Treatment of Orbital Complications Following Acute Rhinosinusitis in Children.

The orbital complications account for about 80% of all complications secondary to acute rhinosinusitis. If the treatment is not correct and in time, orbital complications could progress rapidly, leading to optic neuritis, cavernous sinus thrombophlebitis or life-threatening intracranial complications. To evaluate the therapeutic efficacy of conservative therapy for the patients with orbital cellulitis and endoscopic sinus surgery (ESS) performed on patients with subperiosteal abscess (SPA) secondary to acute rhinosinusitis in children. Retrospective cross-sectional study. The retrospective study included 31 pediatric patients with orbital complications secondary to acute rhinosinusitis. In all cases, intensive treatment was initiated with a combination of oral or intravenous antibiotics, glucocorticoid and gelomyrtol forte after admission. ESS was performed if an improvement in the condition of patients did not occur after 48 hours. However, the patients with orbital SPA, motility disorders of eyeball or decreased vision received ESS immediately within 24 hours. Sixteen patients were cured by conservative therapy and 15 patients by ESS. All of the signs and symptoms disappeared after conservative therapy or ESS. There were no recurrences within the follow-up period of 1 to 8 years. Conservative therapy is an effective method for patients with inflammatory edema and most cases of orbital cellulitis in children. SPA can be cured by ESS.

Pediatric orbital cellulitis in the Haemophilus influenzae vaccine era.

To evaluate the microbiology of pediatric orbital cellulitis in blood cultures and abscess drainage cultures following the introduction of the Haemophilus influenzae serotype b (Hib) vaccine. The medical records of all pediatrics patients (aged <18 years) at a tertiary pediatric hospital during the period January 2000 to July 2011 with a computed tomography orbital imaging querying "orbital cellulitis," "periorbital cellulitis," "preseptal cellulitis," or "post-septal cellulitis" were retrospectively reviewed. The records, microbiology, and radiology of these patients were reviewed to assess the rates and complications of H. influenzae orbital cellulitis, including bacteremia and meningitis. A total of 149 patients were diagnosed with preseptal or orbital cellulitis, of whom 101 (mean age, 7.2 ± 4.0) had true orbital cellulitis. No patients grew H. influenzae from blood cultures. Of the 101 patients, 30 (29.7%) required surgical drainage and had abscess drainage fluid sent for microbiology. Of these, 18 (64.3%) had a positive culture: 4 (13.3%) grew H. influenzae from their abscess drainage fluid samples; 1 grew H. influenzae alone; and 3 had mixed growth that included H. influenzae. The patients positive for H. influenzae were significantly older and had significantly larger abscesses. Although there were no cases of H. influenzae bacteremia or meningitis in our cases of orbital cellulitis, abscess drainage fluid microbiology indicated that H. influenzae remains a cause of orbital cellulitis. H. influenzae abscess volume was significantly larger than other bacterial abscesses and was associated with abscesses of mixed bacterial growth in older children.

Orbital cellulitis and intraconal abscess formation after strabismus surgery in an adult patient

We report a 60-year-old woman who presented with orbital cellulitis, restricted ocular motility, proptosis, and visual acuity of counting fingers in her left eye 3 days after strabismus surgery. Although she initially responded well to antibiotic and anti-inflammatory therapy, visual acuity in the left eye again decreased on postoperative day 5. Radiographic imaging revealed an intraconal orbital abscess, and she underwent left lateral orbitotomy with abscess drainage, with continued antibiotics and a tapering dose of steroids. To our knowledge, this is the first case of orbital cellulitis and intraconal abscess after strabismus surgery in an adult.

Management of Orbital Complications of Sinusitis in Pediatric Patients

The most common reason of orbital infections is sinusitis. Orbital complications of sinusitis are mostly seen in children. Loss of vision and intracranial infections are among the complications of sinusitis. Prompt diagnosis and treatment is very important in the management of orbital complications. The orbital complication can be in the form of cellulitis or abscess. A retrospective review of 26 pediatric patients with orbital complications due to sinusitis was presented in this study. Of 26 patients, there were 13 cases of preseptal cellulitis, 2 cases of orbital cellulitis, and 11 cases of subperiosteal abscess. We grouped the preseptal and orbital cellulites in one category and the subperiosteal abscess in the other. All patients in the cellulitis group recovered by medical treatment. All the patients were treated by surgical drainage. Early diagnosis and appropriate treatment method are vital for the treatment of orbital complications secondary to sinusitis.

Paranasal sinus infection causing orbital subperiosteal abscess: surgical management of this devastating entity

Orbital infection is an uncommon devastating infection and is usually a complication of paranasal sinus infection. Without appropriate treatment, orbital infection may lead to serious complications, even death. Prompt treatment is mandatory to avoid visual loss or intracranial complications. The literature shows that initially, intravenous antibiotics should be administered, and after 48h, if no improvement appears, the affected orbit and the sinuses must be surgically drained. The authors describe two cases of orbital cellulitis with a brief literature review. The authors describe two cases of orbital abscess caused by paranasal sinus infection. In case 1, the patient presented a decreased visual acuity associated with ophthalmoplegia of the right eye. In case 2, the patient presented a decreased visual acuity. Thus, administration of intravenous antibiotic combined with surgical drainage was performed. After surgical procedure, eye movements were normalized in case 1, and in both patients, the visual acuity returned to normal parameters. The authors recommend early surgical drainage with parenteral antibiotic administration and careful postoperative observations by monitoring the signs and symptoms of the orbital complaint.

Bactériémie sur infection du cathéter fémoral : une cause inhabituelle de cellulite orbitaire

The authors report a case of orbital cellulitis complicating bacteremia on central catheter infection. A 51-year-old man, with a history of diabetes and end-stage renal disease, was admitted for left exophthalmos with inflammatory chemosis, fever, and worsening of his general state. The CT scan showed exophthalmos with thickening of soft tissues and infiltration of the ocular fat without collection or sinus impairment. Orbital cellulitis was diagnosed. The etiological investigations showed Staphylococcus aureus bacteremia on femoral catheter infection. Progression was favorable with antibiotics and nursing care. The authors discuss the compromised prognosis of this disease and the need for rapid diagnosis and prompt therapeutic management.

Orbital cellulitis and endogenous endophthalmitis secondary to Proteus mirabilis cholecystitis

We report the first case of orbital cellulitis and endogenous endophthalmitis secondary to Proteus mirabilis bacteremia that resulted from a calculus cholecystitis. Despite resolution of the gallbladder infection with antimicrobial therapy, the patient required evisceration of the affected eye. The pathogenesis of hematogenous endophthalmitis due to Gram-negative bacilli is discussed.

A case of orbital cellulitis and pan-ophthalmitis in dengue haemorrhagic fever in a child

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

Orbital Cellulitis With Subperisoteal Abscess Secondary to Dental Extraction

Purpose: We report a case of orbital cellulitis with subperiosteal abscess secondary to dental extraction. Case summary: A 55-year-old man presented to the emergency department with severe erythematous, painful swelling of the left periorbital area and the upper cheek after extraction of the left maxillary molar and premolar teeth. Computed tomography scan demonstrated marked periorbital inflammation and medial displacement of the left lateral rectus muscle by subperiosteal abscess extending along the lateral orbital wall. After a 10-day course of intravenous broad spectrum antibiotics and a 7-day course of oral prednisolone, he achieved complete resolution of all clinical symptoms and signs. Conclusions: Physicians should keep in mind that orbital complications may occur after oral surgery. A high level of suspicion in a patient with preceptal signs and a history of recent tooth infection or extraction is needed to avoid missing a diagnosis.