ORBITAL Ultrasonography a diagnosis tool in early cellulitis

Abstract

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.