Download MBBS Ophthalmology PPT 40 Orbital Cellulitis Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Ophthalmology PPT 40 Orbital Cellulitis Lecture Notes




Bony house of eyeball

Protects the eye

Facilitates motility

Contents:
Eyeball

Nerves ? II,III,IV,VI and part of V nerve

Blood vessels

Lacrimal gland






Pear shaped cavity

Four walls tapering posteriorly

Formed by Seven bones

Volume ? 30 ml

Three walls are related to paranasal sinuses

Horizontal CT

Coronal CT




Preseptal cellulitis

Post Septal cellulitis/Orbital cellulitis

-Orbital cellulitis is purulent inflammation of

eye tissues behind the orbital septum

Extension from neighbouring structures :

Parasnasal sinuses, Teeth, Face, Lids, Intracranial

cavity, Intraorbital structures

Exogenous Infection : Foreign body, Penetrating

injury, Evisceration, Enucleation,

Dacryocystectomy, Orbitotomy


Endogenous infection : Puerperal sepsis,

Thrombophlebitis of leg, Septicemia, rarely as

metastasis from Ca Breast

Predisposing factors like Diabetes mellitus and

Immunocompromised state also increases risk of

infection.




BACTERIA
?Childrens- Staph aureus, Strep pneumoniae

and anaerobics
?Adults- Staph aureus, Strep pneumoniae,

E.coli,mixed flora
FUNGUS
Diabetics and Immunocompromised
Aspergillus, Mucor species
PARASITE
?Ecchinococcus Granulosus ?Taenia solium

?Trichinella spiralis ?Toxoplasma gondii

Are similar to suppurative inflammations of the

body in general, except that

Due to the absence of a lymphatic system the

protective agents are limited to local phagocytic

elements provided by the orbital reticular tissue

Due to tight compartments, the intraorbital

pressure is raised which augments the virulence of

infection causing early and extensive necrotic

sloughing of the tissues

As in most cases the infection spreads as

thrombophlebitis from the surrounding structures,

a rapid spread with extensive necrosis is the rule




High Fever

Painful swelling of upper and lower lids

Eyelid appears shiny and is red or purple in

color

Infant or child is acutely ill or toxic

Eyepain Especially with movement

Decreased vision

Eye bulging

General malaise

Restricted or painful eye movements

A marked swelling of the lids characterised

by woody hardness and redness

A marked chemosis of conjunctiva, which

may protrude and become desiccated or

necrotic

The eyeball is proptosed axially
Frequently, there is mild to severe

restriction of the

ocular movements
Fundus examination may show congestion of

retinal veins and signs of papillitis or

papilloedem




Cavernous sinus thrombosis

Endocrine dysfunction

Orbital myositis

Orbital pseudotumor

Wegener granulomatosis

CHANDLER CLASSIFICATION
- Group 1 - Pre-septal Cellulitis
- Group 2 - Orbital Cellulitis
- Group 3 - Subperiosteal abscess
- Group 4 - Orbital abscess
- Group 5 - Cavernous sinus thrombosis




Complete blood count

Blood culture

Urine culture

B scan

CT Scan

MRI

IV Antibiotics - anti biotic therapy should be

continued until patient is apyrexic for 4 days

Antifungals
Nasal decongestants
Diuretics to reduce the IOP
Lumbar puncture is done in meningeal or lumbar

signs develop and It is useful to do the swinging

light test to check for a Marcus Gunn pupil,

which would indicate optic nerve damage

Frequent ophthalmic assessment is mandatory in

case of intra cranial abscess formation,

neurosurgical drainage may be necessary




Ocular ? Exposure Keratitis , Raised IOP,

CRAO, CRVO, Optic Atrophy

Orbital ? Subperiosteal abscess, Orbital

abscess

Cavernous sinous thrombosis

Meningitis, Brain abscess

Bacteremia



























This post was last modified on 07 April 2022