Diagnosis Of Orbital Cellulitis Research Articles

Successful Management of Neonatal Orbital Cellulitis: A Rare Case Report

Objective: To report a rare case of neonatal orbital cellulitis along with the successful management. Introduction: Orbital cellulitis is a sight- and life-threatening infection of the post-septal tissues of the orbit, and is a considerably rare finding in neonates. Prompt diagnosis and treatment is essential, as 11-26% of cases of orbital cellulitis result in death and visual loss. Case Presentation: A one-month-old neonate presented with rapidly progressive swelling and redness of the right eyelid along with persistent subfebrile fever seven days before admission to the hospital. Blinking reaction to light stimulation was good on the left eye. Ocular motility was difficult to be evaluated. Conjunctival appearance on the right eye showed severe chemosis, while the other parts of both eyes were within normal limit. Orbital Computed Tomography (CT) scan revealed diffuse soft-tissue swelling at the superior and inferior palpebra of the right eye and partial erosion of the lateral wall of the right ethmoidal sinus, suggesting sino-orbital inflammation. Diagnosis of orbital cellulitis was confirmed on the right eye in this patient. Incision and drainage surgery of the right eyelids were done immediately as improvement was only seen on the upper eyelid after empirical intravenous (IV) antibiotic administration. Strain of Methicillin-Resistant Staphylococcus Aureus (MRSA) was found from the discharge’s culture. At one month follow up, the swelling of the right eyelid had markedly decreased with no signs of inflammation. Conclusion: This case highlights and showed a rare case and successful management of neonatal orbital cellulitis. Early diagnosis and prompt treatment of neonatal orbital cellulitis may benefit patient and prevent sight- and life-threatening condition.

ORBITAL Ultrasonography a diagnosis tool in early cellulitis

The term cellulitis in general parlance refers to non-suppurative invasive infection (most commonly bacterial) of subcutaneous tissue. Spreading infection, poor localization in addition to cardinal signs of inflammation are the hallmark of cellulitis. Cellulitis can be complicated by spread of infection to the underlying deeper structures with progressive tissue destruction & ulceration with release of bacterial toxins. (1) Orbital cellulitis is an infection of the fat and ocular muscles of the orbit posterior to the orbital septum. It is classically distinguished clinically from pre-septal cellulitis by the presence of pain with eye movement and proptosis on physical examination (1, 2). What makes cellulitis in the preseptal, orbital & retro-orbital soft tissue regions different from generalized cellulitis are the transitional anatomical differences from preseptal (Eyelid skin) to adnexal/orbital to intracranial structures and the presence of well recognized anatomical/surgical sub-compartments. Preseptal cellulitis follows pattern similarities to generalized cellulitis characterized by eyelid edema, eyelid erythema, local rise of temperature and tenderness. Unlike pre-septal cellulitis, orbital cellulitis is considered a medical emergency. If left untreated, it can lead to permanent vision loss, brain abscesses, meningitis, and cavernous sinus thrombosis (3). Though the diagnosis of orbital cellulitis can be made clinically, imaging modalities such as computed tomography (CT) and Orbital Ultrasonography are commonly used to confirm the diagnosis. (4) The present study was designed to provide sequential imaging to visualize the disease progression.

Point-of-Care Ultrasound Findings in a Case of Orbital Cellulitis: A Case Report

Ophthalmologic complaints are common in the emergency department. The utility of point-of-care ultrasound (POCUS) as an accessible, noninvasive modality to evaluate ocular pathology is of great value-particularly in settings where resources are limited or where ophthalmologic consultation may not be readily available. A 21-year-old woman presented to the emergency department with periorbital edema, erythema, and drainage that was worsening despite topical and oral antimicrobial therapy. Mild proptosis was present on examination. POCUS was performed to investigate her symptoms further. A modified ocular ultrasound revealed prominence and edema of the retro-orbital soft tissue with echogenic fat, consistent with the diagnosis of orbital cellulitis. These findings were corroborated with computed tomography imaging. Why Should an Emergency Physician Be Aware of This?: Few reports describe the utility of POCUS in evaluating patients for orbital cellulitis. This case emphasizes the value of POCUS in assessing patients presenting to the emergency department with ocular complaints and demonstrates ultrasound-specific findings that may lead the clinician toward the diagnosis of orbital cellulitis. © 2021 Elsevier Inc.

Posterior Scleritis Mimicking Orbital Cellulitis: A Report of the Three Cases

Objective: To report on three cases of posterior scleritis presenting as orbital cellulitis. Case Report: The authors retrospectively reviewed the medical records of three patients who were diagnosed as posterior scleritis but initially presented as orbital cellulitis. All patients were young males who presented with pain, unilateral proptosis, eyelid swelling with redness, and limitation of ocular movement. Initially, the diagnosis of orbital cellulitis was suspected and patients had been treated with systemic antibiotics but with no clinical improvement. Systemic work-up for infections and autoimmune diseases were negative. The orbital computed tomography (CT) scans showed severe posterior eyewall thickening with associated soft tissue edema. Ultrasonography showed a typical T-sign, compatible with posterior scleritis. Specific cause of scleritis or an association with systemic disease was not established. Systemic corticosteroids (1 mg per kg per day) were administered, and all patients improved within several days. Conclusion: Posterior scleritis is a rare and severe ocular inflammatory disorder that can mimic orbital cellulitis. Early detection and prompt treatment is crucial. Keywords: Posterior scleritis, Orbital cellulitis, Non-specific orbital inflammation, Orbital computed tomography scan, T-sign ultrasonography

Atypical presentations of orbital cellulitis in an 11-year-old boy

Spontaneous acute-onset proptosis accompanied with inflammatory signs in children is commonly caused by orbital cellulitis/abscess; however, the clinician should always be alert to the possibility of other causes such as neoplastic: Orbital rhabdomyosarcoma (RMS), traumatic, and iatrogenic factors. This is a case report of an 11-year-old boy presenting with an acute-onset non-axial proptosis of the left eye without a history of trauma, sinus disease, or systemic infection. Our clinical differential diagnosis included orbital cellulitis and orbital RMS. However, the final diagnosis was orbital cellulitis with abscess. The purpose of the study was to report a case of “cold” orbital abscess that clinically mimics orbital RMS. An 11-year-old boy presented with a 2 weeks history of painless, rapid-onset non-axial proptosis in the left eye. It was associated with periorbital edema, and mild conjunctival hyperemia. There was no preceding or associated history of fever, trauma, upper respiratory tract infection, sinusitis, or immunosuppression. An initial clinical diagnosis of RMS, with orbital cellulitis as a differential diagnosis, was made delaying commencement of antibiotic therapy. Following the drainage of greenish tinged purulent matter growing Staphylococcus aureus on culture, the diagnosis of orbital cellulitis with abscess was made. A broad-spectrum antibiotics and subsequent adjunct anti-inflammatory therapy yielded excellent clinical resolution. The case demonstrates the pitfalls/challenges in differentiating orbital space occupying lesions manifesting with inflammatory features on the basis of clinical findings alone. This is particularly relevant in a busy triage ophthalmic clinic in a low resource environment without easy access to any form of orbital imaging. In addition, the case highlights that green tinged purulent matter can be found in infections from a myriad of organisms aside from the popularly known Pseudomonas aeruginosa.

Invasive Fungal Keratitis as an Uncommon Form of Mucormycosis Leading to Endophthalmitis: Report of Two Cases and Literature Review

This study was conducted to report two cases of fungal keratitis caused by mucormycetes that led to endophthalmitis. Case number 1: a 24-year-old male, with a known case of thalassemia major, presented with chief complaints of painful periorbital edema and redness in the left eye. Intravenous antibiotics were prescribed upon diagnosis of orbital cellulitis, but it progressed to the cornea and sclera and led to endophthalmitis, which was treated with penetrating keratoplasty (PK) combined with deep vitrectomy. Case number 2: a 6-year-old healthy boy presented to the ophthalmology emergency room with ocular pain and redness in his right eye. He had a history of swimming in a river 2 weeks prior to presentation. At the time of presentation, eye examinations showed a dense stromal infiltration with hypopyon. He underwent therapeutic PK due to progression of infiltration to the total cornea and limbus. After the first PK, the patient underwent combined Re-PK and deep vitrectomy, because of recurrence of infection on graft and development of endophthalmitis. The infection relapsed on corneal graft and visual acuity decreased to no light perception. For this patient, enucleation was performed in order to prevent spread of infection to the orbit and brain. Fungal keratitis caused by mucormycetes as an uncommon infection might occur in healthy individuals. Accordingly, timely diagnosis and administration of appropriate antimicrobial agents are vital. In fungal keratitis, patients who have intraocular involvement and are unresponsive to initial antifungal therapy should be evaluated regarding suspicion of mucormycetes.

Management of orbital cellulitis: a retrospective study

Background: Orbital cellulitis is an infectious involvement of the tissues posterior to the orbital septum causing severe local and general complications. Material and methods: The aim of our work was to study the clinical, paraclinical and therapeutic characteristics of orbital cellulitis through a retrospective study of 89 cases collected between 2015 and 2019. The diagnosis of orbital cellulitis was based on clinical and imaging elements. Results: The average age was 17.5 years. Exophthalmos was noted in 33% of cases, ophthalmoplegia in 18% of cases, diplopia in 4.5% of cases and ocular hypertonia in 11% of cases. Orbital CT scan allowed the diagnosis of subperiosteal abscess in 20% of cases and orbital abscess in 10% of cases. Sinusitis was the main infectious origin in children, while dacryocystitis predominated in adults. All patients received parenteral antibiotherapy combined with corticotherapy after 48 hours. Complications occurred in 10 cases, dominated by exposure keratitis, panophthalmitis and optic atrophy with permanent blindness. Conclusions: We emphasize the importance of rapid diagnosis and urgent treatment of orbital cellulitis.

Fatal orbital cellulitis with intracranial complications: a case report

BackgroundOrbital cellulitis is a relatively uncommon presentation in the emergency department, but orbital cellulitis complicated by intracranial extensions, loss of vision, and death has rarely been reported in the literature.Case presentationWe report a 40-year-old Pakistani diabetic male complaining of 5 days of bilateral eye pain, proptosis, ophthalmoplegia, headache, and fever. A diagnosis of orbital cellulitis with intracranial extension was made. A computed tomography (CT) scan and a magnetic resonance imaging (MRI) were done on the patient and showed unremarkable orbits, extensive sinusitis, frontal abscess, and multiple septic emboli. The patient was admitted and on day 9 deteriorated and died.ConclusionOrbital cellulitis associated with intracranial extension is an extremely rare presentation, and the incidence is unknown. The use of contrast-enhanced imaging studies (CT/MRI) early on in the management of suspected orbital cellulitis is supported by the literature. Cerebritis and brain abscesses resulting from orbital cellulitis need advanced care from multidisciplinary teams. Further studies need to be done to provide recommendations on the use and benefit of surgical intervention.

Orbital Cellulitis And Subperiosteal Abscess Of Frontal Bone Complicating Unilateral Pansinusitis: A Case Report

Objective: The aim of this report is to demonstrate that acute rhino-sinusitis may result in orbital cellulitis and even life threatening complications especially intracranial abscesses in children and young adults. Rare complications such as subperiosteal abscess seen in this patient may also occur Morbidity and mortality can be prevented through early diagnosis and treatment by relevant specialists.
 Method: We present a case report and literature review on unilateral pansinusitis complicated with orbital cellulitis and subperiosteal abscess of the frontal bone.
 Results: Following a diagnosis of orbital cellulitis and subperiosteal abscess of the frontal bone from a unilateral pansinusitis, an initial intravenous antibiotic was given for 72 hours, followed by a surgical drainage with subsequent rapid improvement.
 Conclusion: Acute rhinosinusitis may be complicated by orbital cellulitis and abscess formation. Prompt referral to a tertiary health facility as well as ooperation between the Ophthalmologists and Otorhinolaryngologists is very important to prevent life threatening complications.
 Key words: Orbital cellulitis, Pansinusitis, Subperiosteal abscess

Ultrasound evaluation of normal orbital preseptal thickness

Orbital preseptal thickness is an important parameter not only in diagnosis of orbital cellulitis but also in recent classification and management of dark eye circle (DEC). The aim of this study was to evaluate normal preseptal thickness and collect baseline data in normal skin in a given population with no orbital pathology. Ultrasound was performed on 42 patients (23 females and 19 males) with clinically normal eyes and orbits for evaluation of normal orbital preseptal thickness. The age ranged between 15 to 35 years with a mean age of 24.9 years. Our study concluded that normal preseptal thickness ranged from 2.1 mm to 5.5 mm. Mean preseptal thickness for both sides was 3.9 mm. Ultrasound can be used as quick, reliable and cost-effective modality for evaluation of orbital preseptal thickness.

Advanced Case of Rhabdomyosarcoma of Orbit Mimicking Orbital Cellulitis

Rhabdomyosarcoma is a malignant neoplasm of primitive mesenchyme exhibiting skeletal muscle differentiation. Rhabdomyosarcoma, which can histopathologically be of embryonal, alveolar, botryoid and pleomorphic types; is a rare tumor in children, with an annual incidence of 4.3 cases per million. Pleomorphic rhabdomyosarcomas is a rare variant, occurring more commonly in adults. We report a rare case of ocular pleomorphic rhabdomyosarcoma in an 18-month-old child with atypical presentation mimicking orbital cellulitis. A provisional diagnosis of orbital cellulitis was made based on clinical and radiological examination and was planned for surgery. Histopathology confirmed the diagnosis of pleomorphic rhabdomyosarcoma. This case shows that pleomorphic rhabdomyosarcoma may also occur in children, it may mimic symptoms of orbital cellulitis, and any fast growing swelling should be carefully examined with a high degree of suspicion of this entity.

A rare case of idiopathic orbital inflammatory syndrome

A 65-year-old woman presented with swelling and pain at the superomedial aspect of the right eye that was associated with proptosis, ptosis and restriction of eye movements superiorly and medially since 1 month. Considering the age and clinical presentation of the patient, a differential diagnosis of orbital cellulitis, thyroid orbitopathy, ocular myasthenia, orbital neoplasm, lymphoproliferative disorder and idiopathic orbital inflammatory syndrome (IOIS) was considered. Relevant laboratory investigations were performed, which were normal. Computed tomography, magnetic resonance imaging and biopsy were suggestive of IOIS. The patient was started on oral steroids and had a favorable outcome.

Orbital Complications of Acute Sinusitis

The widespread use of the 7-valent pneumococcal conjugate vaccine (PVC7), developed to combat invasive Streptococcus pneumoniae infections, has the potential to influence the prevalence and antibiotic resistance patterns of pathogens associated with orbital complications from acute sinusitis. Given the significant morbidity that may result from inadequate treatment of orbital infections related to acute sinusitis, determining the impact of PCV7 on the bacteriology and drug resistance of the pathogens associated with these infections may provide critical information needed to accurately guide optimal clinical management. To determine if the characteristics of orbital complications from acute sinusitis in children have changed in the post-PCV7 era. Review of clinical data. Tertiary care children's hospital. Patients with a diagnosis of orbital cellulitis and/or subperiosteal abscess from January 1, 1996, to December 31, 2009. Patients with immune deficiency or orbital trauma were excluded. Patients were divided into pre-PCV7 (before 2003 [n = 128]) and post-PCV7 (2003 and after [n = 145]) groups. Statistical analyses were used to compare the 2 groups. Differences in patient demographics, signs and symptoms, laboratory study results, computed tomography scan findings, and microbiological analyses between the pre-PCV7 and post-PCV7 groups. A total of 273 children met the inclusion criteria. The post-PCV7 group was older (71.4 months vs 88.8 months [P = .007]) than the pre-PCV7 group. A significant decrease in S pneumoniae and Streptococcus viridans -positive sinus or blood cultures were observed (22.4% vs 0% [P < .001] and 12.24% vs 0% [P = .005], respectively). An increase in Staphylococcus aureus was seen in the post-PCV7 group (20.4% vs 42.37% [P = .02]). Methicillin-resistant S aureus (MRSA) was isolated only in the post-PCV7 group (P = .002). The pre-PCV7 group had a significantly longer hospital stay than the post-PCV7 group (7.15 days vs 5.47 days [P = .004]). Although universal PCV7 vaccination has eliminated S pneumoniae as an etiologic pathogen in acute sinusitis complications in this series, there has been a parallel and significant increase in S aureus, including an increase in the prevalence of MRSA associated with orbital infections related to acute sinusitis.

Bedside ultrasound in the diagnosis of orbital cellulitis and orbital abscess

Bedside ultrasound in the diagnosis of orbital cellulitis and orbital abscess

Orbital and Periorbital InfectionsOrbital and Periorbital Infections

Objectives: To describe the epidemiologic features of pediatric orbital and periorbital infections from a national perspective and to identify predictors of surgery. Design: Analysis of the Kids' Inpatient Database. Setting: Administrative data set. Patients: Pediatric inpatient admissions with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of orbital cellulitis. Main Outcome Measures: Hospital admission, socioeconomic, and clinical variables were examined and predictors of surgical intervention were evaluated using logistic regression. Results: A total 5440 hospital admissions was noted for pediatric orbital cellulitis; of these, 672 patients (12.4%) underwent surgical intervention. Mean length of stay for all patients was 3.8 days; 90.4% were routinely discharged. Patients who had surgery were older, with a mean (SE) age of 10.1 (0.29) years compared with 6.1 (0.10) years for nonsurgical patients (P Conclusions: This study describes the medical and surgical management of pediatric orbital and periorbital infections from a national perspective. Predictors of surgical intervention include older age, presentation with diplopia, and hospital admission via the emergency department. Knowledge of these variables facilitates analysis of resource utilization for pediatric orbital cellulitis and can be used to optimally triage patients, ultimately reducing costs and lengths of stay while preserving quality of care.

Subperiosteal Abscess of the Orbit

To report the duration of intravenous (IV) antibiotic administration and outcomes in a cohort of patients with subperiosteal abscess (SPA) of the orbit triaged to nonsurgical management. A retrospective cohort study based on records of patients younger than 9 years admitted to a regional pediatric hospital with a diagnosis of orbital cellulitis from 1999 through 2008. Patients with computed tomography (CT)-confirmed SPA and associated sinusitis were included. Patients who underwent surgical drainage of sinuses and/or orbits during that admission were excluded. Patients discharged with a peripherally inserted central catheter for a predetermined treatment interval were excluded. Dates and times of first and last doses of inpatient IV antibiotics were recorded. Records were reviewed for evidence of hospital readmission for relevant diagnoses. Outcome measures included duration of IV antibiotic administration and hospital readmission. Forty-two patients met study criteria. Duration of IV treatment ranged from 2 to 8 days (mean and median, each 4 days). Forty-one patients were not readmitted with a relevant diagnosis from the time of hospital discharge to completion of data acquisition in April 2011. One patient was readmitted for recurrent acute infection 10 weeks after discharge and underwent urgent SPA and sinus drainage; review of the initial CT revealed an ethmoidal mucocoele. The duration of IV therapy associated with successful nonsurgical management of appropriately selected children with SPA is considerably shorter than that recommended in current pediatric infectious disease literature. The findings suggest that clinical judgment, based on each patient's initial CT findings and evolving signs, symptoms, and laboratory profile, should be a major determinant of IV intervals.

A review of orbital and intracranial magnetic resonance imaging in 79 canine and 13 feline patients (2004–2010)

To review the distribution of orbital and intracranial disease in canine and feline patients undergoing magnetic resonance imaging (MRI) following referral to a veterinary ophthalmologist and to correlate results of MRI with pathologic conditions including neoplasia, suspected optic neuritis (ON) and orbital cellulitis. Recognized and emerging imaging techniques are reviewed. Medical records of 79 canine and 13 feline patients were reviewed. Neoplasia was diagnosed in 53/92 (57.6%) of patients. The most prevalent types of neoplasia were carcinoma (16/53, 30.1%), sarcoma (11/53, 20.8%), lymphoma (8/53, 15.1%) and presumptive meningioma (9/53, 17.0%). Carcinomas and sarcomas were characterized by bony lysis and intracranial/sinonasal extension. Lymphoma was generally unilateral, less invasive and originated from the ventromedial orbit. Intracranial masses representing presumptive meningiomas frequently exhibited a 'dural tail' sign. Diagnosis of suspected ON was made in 13 of 92 (14.1%) patients. Results of MRI in patients with suspected ON included unilateral optic nerve hyperintensity (3/13, 23.0%), bilateral optic nerve hyperintensity (1/13, 7.7%) and optic chiasmal hyperintensity (3/13, 23.0%). Seven suspected ON patients demonstrated intracranial multifocal patchy contrast enhancement (7/13, 53.8%). Diagnosis of orbital cellulitis was made in 12/92 (13.0%) patients. Orbital neoplasia was the most common pathologic condition detected. Essential Roentgen characteristics are helpful when diagnosing pathologic processes and providing prognoses in cases of orbital or intracranial disease. Magnetic resonance imaging comprises an important diagnostic component in cases of suspected ON. Emerging contrast and functional MRI techniques as well as SI data may increase our ability to characterize disease processes.

Orbital Cellulitis: Medical and Surgical Management

Introduction: Orbital cellulitis is a potential sight-threatening infection of the ocular adnexal structures posterior to the orbital septum. Acute bacterial sinusitis remains the most common cause of orbital cellulitis.Methods: A retrospective chart review was performed for patients admitted to The Royal Victorian Eye and Ear Hospital with a diagnosis of orbital cellulitis over a five-year period to July 2009.Results: 78 patients were identified for inclusion in the study, median age 42 years. Sinusitis was the most common predisposing factor, and was present in 52 patients (67%). All patients were treated with intravenous antibiotics. Surgical drainage was required for 28 patients (36%). Of these patients, 3 underwent endoscopic drainage only, 21 underwent open drainage, and 4 patients underwent a combination of open and endoscopic drainage. The most significant complication seen was persistent decreased visual acuity despite treatment, which was present in 5 patients (6%).Discussion: Orbital cellulitis remains a potentially sight-threatening infection that requires careful management, preferably by combined ENT and Ophthalmology teams. Surgery is reserved for those patients in whom signs of visual compromise are present initially, or in those who fail to improve with maximal medical management. Currently endoscopic drainage is not the most common surgical approach, however for selected patients it appears a safe comparable alternative.

Post-traumatic orbital cellulitis

The above patient with previous maxillofacial trauma presented with a 3-day history of pain, swelling, proptosis and decreased visual acuity (6/12) in the left eye. He had a pyrexia of 38.9 °C, WBC of 20.1 and a CRP of 91. A diagnosis of orbital cellulitis was suspected. Due to the potential for loss of sight an urgent CT was arranged and orbital decompression and maxillary sinus wash-out were undertaken. Pus swabs grew H. influenza and group C streptococci; blood culture was positive for peptostreptococi which responded to benzylpenicillin, metronidazole and flucloxacillin.

Orbital Cellulitis in Children

To review the epidemiology and management of orbital cellulitis in children. The medical records of children < or = 18 years old and hospitalized from June 1, 1992, through May 31, 2002, at the Brenner Children's Hospital, with a discharge ICD-9 code indicating a diagnosis of orbital cellulitis and confirmed by computed tomography scan were reviewed. A literature search for additional studies for systematic review was also conducted. Forty-one children with orbital cellulitis were identified. The mean age was 7.5 years (range, 10 months to 16 years), and 30 (73%) were male (male:female ratio = 2.7). All cases of orbital cellulitis were associated with sinusitis; ethmoid sinusitis was present in 40 (98%) patients. Proptosis and/or ophthalmoplegia was documented in 30 (73%), and 34 (83%) had subperiosteal and/or orbital abscesses. Twenty-nine (71%) had surgical drainage and 12 (29%) received antibiotic therapy only. The mean duration of hospitalization was 5.8 days. The mean duration of antibiotic therapy was 21 days. Orbital cellulitis occurs throughout childhood and in similar frequency among younger and older children. It is twice as common among males as females. Selected cases of orbital cellulitis, including many with subperiosteal abscess, can be treated successfully without surgical drainage.