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


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


?Childrens- Staph aureus, Strep pneumoniae

and anaerobics
?Adults- Staph aureus, Strep pneumoniae,

E.coli,mixed flora
Diabetics and Immunocompromised
Aspergillus, Mucor species
?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


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


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


Cavernous sinus thrombosis

Endocrine dysfunction

Orbital myositis

Orbital pseudotumor

Wegener granulomatosis

- 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


IV Antibiotics - anti biotic therapy should be

continued until patient is apyrexic for 4 days

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


Cavernous sinous thrombosis

Meningitis, Brain abscess


This post was last modified on 07 April 2022