Facilitates motility
Contents:
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EyeballNerves ? II,III,IV,VI and part of V nerve
Blood vessels
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Lacrimal gland
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Pear shaped cavity
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Four walls tapering posteriorlyFormed by Seven bones
Volume ? 30 ml
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Three walls are related to paranasal sinuses
Horizontal CT
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Preseptal cellulitisPost Septal cellulitis/Orbital cellulitis
-Orbital cellulitis is purulent inflammation of
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eye tissues behind the orbital septum
Extension from neighbouring structures :
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Parasnasal sinuses, Teeth, Face, Lids, Intracranialcavity, Intraorbital structures
Exogenous Infection : Foreign body, Penetrating
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injury, Evisceration, Enucleation,
Dacryocystectomy, Orbitotomy
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Endogenous infection : Puerperal sepsis,
Thrombophlebitis of leg, Septicemia, rarely as
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metastasis from Ca BreastPredisposing factors like Diabetes mellitus and
Immunocompromised state also increases risk of
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infection.
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BACTERIA
?Childrens- Staph aureus, Strep pneumoniae
and anaerobics
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?Adults- Staph aureus, Strep pneumoniae,E.coli,mixed flora
FUNGUS
Diabetics and Immunocompromised
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Aspergillus, Mucor speciesPARASITE
?Ecchinococcus Granulosus ?Taenia solium
?Trichinella spiralis ?Toxoplasma gondii
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Are similar to suppurative inflammations of the
body in general, except that
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Due to the absence of a lymphatic system theprotective agents are limited to local phagocytic
elements provided by the orbital reticular tissue
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Due to tight compartments, the intraorbital
pressure is raised which augments the virulence of
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infection causing early and extensive necroticsloughing of the tissues
As in most cases the infection spreads as
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thrombophlebitis from the surrounding structures,
a rapid spread with extensive necrosis is the rule
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High Fever
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Painful swelling of upper and lower lidsEyelid appears shiny and is red or purple in
color
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Infant or child is acutely ill or toxic
Eyepain Especially with movement
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Decreased visionEye bulging
General malaise
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Restricted or painful eye movements
A marked swelling of the lids characterised
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by woody hardness and rednessA marked chemosis of conjunctiva, which
may protrude and become desiccated or
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necrotic
The eyeball is proptosed axially
Frequently, there is mild to severe
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restriction of the
ocular movements
Fundus examination may show congestion of
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retinal veins and signs of papillitis or
papilloedem
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Cavernous sinus thrombosis
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Endocrine dysfunctionOrbital myositis
Orbital pseudotumor
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Wegener granulomatosis
CHANDLER CLASSIFICATION
- Group 1 - Pre-septal Cellulitis
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- Group 2 - Orbital Cellulitis- Group 3 - Subperiosteal abscess
- Group 4 - Orbital abscess
- Group 5 - Cavernous sinus thrombosis
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Complete blood count
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Blood cultureUrine culture
B scan
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CT Scan
MRI
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IV Antibiotics - anti biotic therapy should becontinued until patient is apyrexic for 4 days
Antifungals
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Nasal decongestantsDiuretics to reduce the IOP
Lumbar puncture is done in meningeal or lumbar
signs develop and It is useful to do the swinging
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light test to check for a Marcus Gunn pupil,
which would indicate optic nerve damage
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Frequent ophthalmic assessment is mandatory incase of intra cranial abscess formation,
neurosurgical drainage may be necessary
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Ocular ? Exposure Keratitis , Raised IOP,
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CRAO, CRVO, Optic Atrophy
Orbital ? Subperiosteal abscess, Orbital
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abscessCavernous sinous thrombosis
Meningitis, Brain abscess
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Bacteremia
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