ORBITAL INFLAMMATIONORBITAL INFLAMMATION

DR. Christina samuel

Pre-Septal cellulitisPre-Septal cellulitisOrbital cellulitisOrbital cellulitisCavernous sinus Cavernous sinus ThrombosisThrombosis

A] preseptal cellulitis B] orbital cellulitisA] preseptal cellulitis B] orbital cellulitis

C] subperiosteal abscess D] orbital abscessC] subperiosteal abscess D] orbital abscess

E] cavernous sinus thrombosisE] cavernous sinus thrombosis

1.1. Preseptal cellulitisPreseptal cellulitis ::– inflammation – inflammation involves structures anterior to the involves structures anterior to the orbital septum.orbital septum.

2. 2. Orbital cellulitis:Orbital cellulitis: the inflammation the inflammation is behind the orbital septum which is behind the orbital septum which may or may not spill over the lidsmay or may not spill over the lids

Preseptal cellulitisPreseptal cellulitisSymptoms & signs:Symptoms & signs: Swelling, erythema, Swelling, erythema,

chemosis of lids chemosis of lids Conjuntival discharge Conjuntival discharge No proptosis, ocular No proptosis, ocular

movements movements Vision not affected Vision not affected

Treatment:Treatment: Antibiotics, NSAIDAntibiotics, NSAID

Orbital cellulitisOrbital cellulitisDef: Purulent inflammation of the cellular tissue

of the orbit.

Cause:

-Spread of inflammation from neighboring parts – nasal sinuses, Dacryocystitis, dental infection, deep injuries, retained foreign body,

-septic operations, DCR, RD, SQUINT

-posterior extension of suppurative infection of eye lid, panophthalmitis, facial erysipelas,

- Metastases in pyaemia

Causative organismsCausative organisms

Streptococcus pneumoniae. Streptococcus pneumoniae.

Staphylococcus aureusStaphylococcus aureus

Streptococcus pyogenesStreptococcus pyogenes

Haemophilus influenzae. (children below 5 years)Haemophilus influenzae. (children below 5 years)

Clinical featuresClinical features1.1. Swelling, erythema, warmth, pain, tendernes of Swelling, erythema, warmth, pain, tendernes of

the lid the lid 2.2. Orbital abscess pointing on the skin or Orbital abscess pointing on the skin or

conjunctivaconjunctiva

3.3. Proptosis – lateral Proptosis – lateral and down and down

4.4. Restriction and pain Restriction and pain of ocular movementsof ocular movements

5.5. Diplopia Diplopia 6.6. Afferent pupillary Afferent pupillary

defect defect 7.7. Diminished vision Diminished vision

due to compression due to compression of optic nerve, its of optic nerve, its blood supply, optic blood supply, optic neuritisneuritis

ComplicationsComplications 1.1. Periorbital abscess Periorbital abscess

2.2. Exposure keratopathy Exposure keratopathy

3.3. C.R.A and C.R.V occlusion C.R.A and C.R.V occlusion

4.4. Panophthalmitis Panophthalmitis

5.5. Intracranial complications Intracranial complications

- meningitis, brain abscess, - meningitis, brain abscess,

- Cavernous Sinus thrombosis - Cavernous Sinus thrombosis

InvestigationsInvestigations1.1. T.C.D.C,ESR T.C.D.C,ESR 2.2. CT orbit, sinus, brain CT orbit, sinus, brain 3.3. Blood, nasal, conjunctival and Blood, nasal, conjunctival and

throat culture and sensitivitythroat culture and sensitivity

TreatmentTreatment1.1. Broad spectrum antibiotic Broad spectrum antibiotic

2.2. N.S.A.I.DN.S.A.I.D

3.3. Steroids Steroids

4.4. Close monitoring by ophthalmologist, neuro Close monitoring by ophthalmologist, neuro surgeon, ENT surgeon surgeon, ENT surgeon

5.5. Surgical – drainage of the abscess, biopsy, Surgical – drainage of the abscess, biopsy, orbital decompressionorbital decompression..

Cavernous Sinus Thrombosis Cavernous Sinus Thrombosis Infection and thrombosis from the face , Infection and thrombosis from the face ,

orbit , mouth, pharynx, ear, nose and orbit , mouth, pharynx, ear, nose and sinuses can spread to the cavernous sinussinuses can spread to the cavernous sinus

The superior ophthalmic vein connects the facial The superior ophthalmic vein connects the facial veins to the cavernous sinusveins to the cavernous sinus

One branch of the inferior ophthalmic vein connects One branch of the inferior ophthalmic vein connects the orbit with that of the cavernous sinus.the orbit with that of the cavernous sinus.

The sinus of the one side communicates with the other The sinus of the one side communicates with the other sideside

The whole venous system in this area is devoid of The whole venous system in this area is devoid of valves.valves.

Clinical features Clinical features Swelling of the lids and chemosis Swelling of the lids and chemosis Proptosis, impaired motility Proptosis, impaired motility Pain, diplopia, fever, headache, altered Pain, diplopia, fever, headache, altered

sensorium, rigors, vomiting, severe cerebral sensorium, rigors, vomiting, severe cerebral symptoms symptoms

the fellow eye is affected in 50% of cases the fellow eye is affected in 50% of cases Papilledema and involvement of the orbital veins are Papilledema and involvement of the orbital veins are

common in cases of otitis media and meningitis and common in cases of otitis media and meningitis and cerebral abscesscerebral abscess

Edema in the mastoid region behind the ear indicates Edema in the mastoid region behind the ear indicates thrombosis of the emissary veinsthrombosis of the emissary veins

Clinical features –cont.,Clinical features –cont., Severe supra orbital pain Severe supra orbital pain

-due to involvement of -due to involvement of ophthalmic division of ophthalmic division of the trigeminal nervethe trigeminal nerve

paralysis of the opposite paralysis of the opposite lateral rectus is the first lateral rectus is the first sign of spread(VI nerve)sign of spread(VI nerve)

Paresis of Paresis of oculomotor(III) nervesoculomotor(III) nerves

Late stages the eye is Late stages the eye is immobile ,pupil is not immobile ,pupil is not acting and cornea is acting and cornea is anaesthetised(V nerve)anaesthetised(V nerve)

TreatmentTreatment

Intra venous broad spectrum antibioticsIntra venous broad spectrum antibiotics Anti coagulantsAnti coagulants Treatment of the cause if it is knownTreatment of the cause if it is known Steroids if there is no contra indicationsSteroids if there is no contra indications A team effort of neurologists ,ENT specialists A team effort of neurologists ,ENT specialists

and ophthalmologists are neededand ophthalmologists are needed

Thank youThank you