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