Orbital Cellulite

Bacterial orbital cellulitis is a life-threatening infectious inflammation of the soft tissues behind the tarzorbital fascia.

It occurs at any age, but more often in children. The most common pathogens are Strep. Pneumoniae, Staph. Aureus, Strep. Pyogenes and H. Influenzae.

[1], [2]

What causes orbital cellulite?

1. Sinusitis, most often etmoiditis, usually affects children and young people.
2. Distribution of preseptal cellulite through the tarzorbital fascia.
3. Distribution of local infection in dacryocystitis. Infection of the middle part of the face, teeth. In the latter case, orbital cellulitis is preceded by inflammation of the maxillary sinus.
4. Hematogenous spread.
5. Posttraumatic develops within 72 hours after damage to the tarzorbital fascia. The clinical picture can be atypical in the presence of a scratch or bruise.
6. Post-surgical as a complication of surgery on the retina, lacrimal organs or orbit.

Symptoms of orbital cellulite

Orbital cellulitis is manifested by pronounced weakness, fever, pain and visual impairment.

• One-sided lesion, tenderness, local increase in temperature, reddening of periorbital tissues and edema of the eyelid.
• Exophthalmos, which is usually hidden by the edema of the eyelid, more often with a shift to the outside and down.
• Ophthalmoplegia with pain when trying to move with the eye.
• Impaired optic nerve function.

Complications of orbital cellulite

1. From the side of the organ of vision: exposure keratopathy, increased intraocular pressure, occlusion of the central artery or vein of the retina, endophthalmitis and optical neuropathy.
2. Intracranial (meningitis, cerebral abscess and cavernous sinus thrombosis) are rare. The latter is extremely dangerous and should be suspected in bilateral symptoms, rapidly growing exophthalmos and stagnant phenomena in the veins of the face, conjunctiva and retina. Additional signs: rapid increase in clinical symptoms of prostration, severe headache, nausea and vomiting.
3. The subperiosteal abscess is more often localized on the inner wall of the orbit. Represents a serious problem, because can quickly progress and spread into the cavity of the skull.
4. Orbital abscess is rarely associated with cellulite orbit and develops after a trauma or surgery.

Prefascial cellulite

Prefascial cellulitis is infectious damage of soft tissues anterior to the tarzorbital fascia. In fact, it does not refer to orbital diseases, but is considered here because it needs to be differentiated from orbital cellulite - a rarer and potentially more serious pathology. Sometimes, rapidly progressing, becomes cellulite of the orbit.

Causes

• a trauma to the skin, for example a scratch or an insect bite. Staph bacteria are usually pathogens. Aureus or Strep. Pyogenes;
• spread of local infection (chalazion or dacryocystitis);
• hematogenous transfer of infection from a distant infectious focus located in the upper respiratory tract or middle ear.

Symptoms: one-sidedness, tenderness, reddening of periorbital tissues and edema of the eyelid.

In contrast to orbital cellulite, there is no exophthalmos. Visual acuity, pupillary reactions and eye movements are not violated.

Treatment: Inside the co-amoxiclav 250 mg every 6 hours. In severe cases, an intramuscular injection of benzylpenicillin can be required totaling 2.4-4.8 mg per A injection and inside the flukloxation 250-500 mg every 6 hours

[3], [4], [5], [6], [7]

Treatment of orbital cellulite

1. It is necessary to be hospitalized with urgent ophthalmologic and otolaryngological examinations. An intracranial abscess may require a neurosurgical drainage operation.
2. Antibiotic therapy consists of intramuscular administration of ceftazidime 1 g every 8 hours and metronidazole inside 500 mg every 4 hours to suppress anaerobic infection. When allergic to penicillin, vancomycin is used intravenously. Antibiotic therapy should continue until the body temperature is normal for 4 days.
3. Functions of the optic nerve. It is necessary to monitor every 4 hours by assessing pupillary reactions, visual acuity, color and eyewitness perception.
4. Studies on indications:
   • Counting the number of leukocytes.
   • Sowing blood.
   • CT of the orbit, sinuses of the nose, brain. CT of the orbit helps to differentiate heavy preseptal cellulite from orbit cellulite.
   • Lumbar puncture in the presence of meningeal or cerebral symptoms.
5. Surgical intervention should be considered when:
   • Inefficacy of antibiotics.
   • Decreased vision.
   • Orbital or suberychiastal abscess.
   • Atypical clinical picture and the need for biopsin.

Usually it is necessary to drain the infected sinus, as well as the orbit.