Clinical profile and outcomes of management of orbital cellulitis in Upper Egypt

Ahmed Mohamed Kamal Elshafei, Mohamed Farouk Sayed, Raafat Mohyeldeen Abdelrahman Abdallah, Ahmed Mohamed Kamal Elshafei, Mohamed Farouk Sayed, Raafat Mohyeldeen Abdelrahman Abdallah

Abstract

Background: The purpose of this paper is to study the etiology, clinical findings, and outcomes of management of cases of orbital cellulitis treated in Minia University Hospital in Upper Egypt over the period of 6 years from July 2009 to July 2015. One-hundred two patients diagnosed to have orbital cellulitis were admitted to the hospital and treated on inpatient basis from July 2009 to July 2015. All patients were subjected to full ophthalmological examination, systemic evaluation, and ear, nose, and throat (ENT) consultation. Axial and coronal CT scan and orbital echography were done for all patients. All patients received medical treatments, and 20 patients needed surgical intervention.

Results: The source of infection was paranasal sinusitis in 66 patients, trauma in 14 cases, panophthalmitis in 6 patients, and dental infection in 2 cases, and no definite source was detected in 14 cases. Subperiosteal abscess (SPA) developed in 16 patients. The final best corrected visual acuity improved in 58% of the cases, decreased in 4%, and remained unchanged in 38% of cases. No intracranial complication was recorded.

Conclusions: Good presenting visual acuity and appropriate medical treatment together with early surgical intervention in cases of SPA are important factors to achieve favorable outcomes in orbital cellulitis. All cases with SPA had paranasal sinusitis, and contrary to previous studies, superior SPA location was the most common followed by the medial location.

Keywords: Orbital cellulitis; Sinusitis; Subperiosteal abscess.

Figures

Fig. 1
Fig. 1
Etiology of orbital cellulitis. a Sinusitis. b Traumatic. c Dental infection
Fig. 2
Fig. 2
Subperiosteal abscess. a Preoperative. b Postoperative
Fig. 3
Fig. 3
Correlation between the duration of hospital admission in days (D) and age of the patients in years (Y)

References

    1. Yen KG, Chilakapati CM, Coats DK. Ocular infectious diseases. In: Feigin RD, Cherry JD, editors. Textbook of pediatric infectious diseases. Philadelphia: Lippincott Williams &Wilkins; 2009.
    1. Ferguson P, McNab A. Current treatment and outcome in orbital cellulitis. Aust N Z J Ophthalmol. 1999;27:375–379. doi: 10.1046/j.1440-1606.1999.00242.x.
    1. Chaudhry A, Shamsi A, Elzaridi E, Al-Rashed W, Al-Amri A, Al-Anezi F, et al. Outcome of treated orbital cellulitis in a tertiary eye care center in the Middle East. Ophthalmology. 2007;114:345–354. doi: 10.1016/j.ophtha.2006.07.059.
    1. McKinley H, Yen T, Miller M, Yen G. Microbiology of pediatric orbital cellulitis. Am J Ophthalmol. 2007;144:497–501. doi: 10.1016/j.ajo.2007.04.049.
    1. Patt S, Manning C. Blindness resulting from orbital complications of sinusitis. Otolaryngol Head Neck Surg. 1991;104:789–795. doi: 10.1177/019459989110400604.
    1. Harris J. Subperiosteal abscess of the orbit. Age as a factor in the bacteriology and response to treatment. Ophthalmology. 1994;101:585–595. doi: 10.1016/S0161-6420(94)31297-8.
    1. Giannoni M, Stewart G, Alford L. Intracranial complications of sinusitis. Laryngoscope. 1997;107:863–867. doi: 10.1097/00005537-199707000-00005.
    1. Chaudhry A, Al-Rashed W, Arat O. The hot orbit: orbital cellulitis. Middle East Afr J Ophthalmol. 2012;19:34–42. doi: 10.4103/0974-9233.92114.
    1. Hodges E, Tabbara F. Orbital cellulitis: review of 23 cases from Saudi Arabia. Br J Ophthalmol. 1989;73:205–208. doi: 10.1136/bjo.73.3.205.
    1. Ambati K, Ambati J, Azar N, Stratton L, Schmidt V. Periorbital and orbital cellulitis before and after the advent of Haemophilus influenzae type B vaccination. Ophthalmology. 2000;107:1450–1453. doi: 10.1016/S0161-6420(00)00178-0.
    1. Fanella S, Singer A, Embree J. Presentation and management of pediatric orbital cellulitis. Can J Infect Dis Med Microbiol. 2011;22:97–100.
    1. Pandian G, Babu K, Chaitra A, Anjali A, Rao A, Srinivasan R. Nine years' review on preseptal and orbital cellulitis and emergence of community-acquired methicillin-resistant Staphylococcus aureus in a tertiary hospital in India. Indian J Ophthalmol. 2011;59:431–435. doi: 10.4103/0301-4738.86309.
    1. Gupta S, Goyal R, Gupta RK. Clinical presentation and outcome of the orbital complications due to acute infective rhino sinusitis. Indian J Otolaryngol Head Neck Surg. 2013;65:431–434. doi: 10.1007/s12070-013-0646-6.
    1. Gellady AM, Shulman ST, Ayoub EM. Periorbital and orbital cellulitis in children. Pediatrics. 1978;61:272–277.
    1. Watters C, Waller H. Acute orbital cellulitis. Arch Ophthalmol. 1976;94:785–788. doi: 10.1001/archopht.1976.03910030387007.
    1. Lee S, Yen T. Management of preseptal and orbital cellulitis. Saudi J Ophthalmol. 2011;25:21–29. doi: 10.1016/j.sjopt.2010.10.004.
    1. Forrester J, Dick A, McMenamin P, Lee W. The eye: basic sciences in practice. 1. London: WB Saunders; 1996.
    1. Yen T, Yen G. Effect of corticosteroids in the acute management of pediatric orbital cellulitis with subperiosteal abscess. Ophthal Plast Reconstr Surg. 2005;21:363–367. doi: 10.1097/01.iop.0000179973.44003.f7.
    1. Harris J. Subperiosteal abscess of the orbit: computed tomography and the clinical course. Ophthal Plast Reconstr Surg. 1996;12:1–8. doi: 10.1097/00002341-199603000-00001.
    1. Howe L, Jones S. Guidelines for the management of periorbital cellulitis/abscess. Clin Otolaryngol. 2004;29:725–728. doi: 10.1111/j.1365-2273.2004.00889.x.
    1. Oxford E, McClay J. Medical and surgical management of subperiosteal orbital abscess secondary to acute sinusitis in children. Int J Pediatr Otorhinolaryngol. 2006;70:1853–1861. doi: 10.1016/j.ijporl.2006.05.012.
    1. Greenberg F, Pollard F. Medical treatment of pediatric subperiosteal orbital abscess secondary to sinusitis. J AAPOS. 1998;2:351–355. doi: 10.1016/S1091-8531(98)90033-7.
    1. Hartstein E, Steinvurzel D, Cohen P. Intracranial abscess as a complication of subperiosteal abscess of the orbit. Ophthal Plast Reconstr Surg. 2001;17:398–403. doi: 10.1097/00002341-200111000-00003.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe