Investigation and management of adult periorbital and orbital cellulitis

Abstract

In this study, sinus disease was the commonest cause of orbital cellulitis, with the commonest organism being Streptococcus milleri. Only 50 per cent of cases with proven disease had had a raised white cell count; this is therefore not a very sensitive test.

Characteristics of patients treated for orbital cellulitis: An analysis of inpatient data

“…This may be explained by patients who initially failed medical therapy or presented with more advanced disease. Similar trends have been observed in prior studies …”

“…Orbital cellulitis, frequently presenting secondary to paranasal sinusitis, is seen in both the pediatric and adult populations . Due to the close relationship of the orbit to the paranasal sinuses, appropriate management and early diagnosis are critical to avoid serious complications that may jeopardize the integrity of the orbit and intracranial structures, resulting in permanent vision loss, optic neuropathy, cavernous sinus thrombosis, brain abscess, meningitis, and possibly death . Chandler et al first described the classification of orbital infections in 1970 that is still referenced today.…”

Orbital infections: five-year case series, literature review and guideline development

“…3,9,10 Abscess formation can be also classified as subperiosteal or intraorbital. 1,[13][14][15][16] Other sources include infections of the adjacent orbital, cranial and facial structures. 1,8,11,12 The most common primary source of infection (60-90 per cent) is the paranasal sinuses, 1,13 mainly the ethmoid and maxillary sinuses.…”

“…Chandler et al published the most commonly used system of classification of orbital and periorbital infections based on disease extent and severity (Table I). 13,16 The infection spreads mainly via the thinned lamina papyracea, localised dissemination of cellulitis and the communicating blood vessels. 1,[13][14][15][16] Other sources include infections of the adjacent orbital, cranial and facial structures.…”

“…8,14,17,18 The condition can result in potentially serious complications such as endophthalmitis, blindness, cavernous sinus thrombosis, intracranial spread and, ultimately, death. 1,5,13,21 To address this, a variety of protocols for managing periorbital or orbital sepsis have been published. 20 Hence, a timely systematic assessment of the disease extent (preseptal and orbital cellulitis vs abscess formation), and prompt treatment are extremely important.…”