orbital infections: review of 28 cases
##plugins.themes.academic_pro.article.main##
Abstract
SUMMARY
Background: Orbital infections (OI) are a serious disorder that may results in visual and systemic morbidity.
Aim : To study epidemiologic data and outcome of OI in a tertiary eye care center.
Methods: Retrospective study of 28 patients (28 eyes) with OI. All patients underwent detailed ophthalmic examination, otolaryngology examination, and cranio-orbital computed tomography scan. All patients received parenteral probabilistic antibiotic treatment then adapted depending on the sensitivity of antibiogram and clinical evolution, associated or not to corticosteroid treatment. The mean follow-up was 14 months.
Results: The mean age of our patients was 35.9 years. Fifteen patients (54%) were male. Of 28 cases, retroseptal cellulitis was the most common, noted in 67.8% of cases. subperiosteal or orbital abscess was recorded in 28.6% of the cases. Sinusitis was the most common etiology, found in 39.3% of cases. Treatment was based on empirical broad spectrum systemic antibiotics in all cases. Surgical management was performed in 39.3% of cases. Bacteriological samples were obtained for 28.5% of patients, with Staphylococcus aureus the most frequently isolated pathogen (5 cases; 62.5%). The evolution was favorable with complete resolution without sequelae in 92.8% of the cases and improvement of visual acuity in 82% of cases. Causes of poor visual outcome were corneal perforation, cataract and retinal detachment.
Conclusions: In our series, OI affects children and young adults. Their prognosis is generally favorable provided rapid and appropriate management.
Background: Orbital infections (OI) are a serious disorder that may results in visual and systemic morbidity.
Aim : To study epidemiologic data and outcome of OI in a tertiary eye care center.
Methods: Retrospective study of 28 patients (28 eyes) with OI. All patients underwent detailed ophthalmic examination, otolaryngology examination, and cranio-orbital computed tomography scan. All patients received parenteral probabilistic antibiotic treatment then adapted depending on the sensitivity of antibiogram and clinical evolution, associated or not to corticosteroid treatment. The mean follow-up was 14 months.
Results: The mean age of our patients was 35.9 years. Fifteen patients (54%) were male. Of 28 cases, retroseptal cellulitis was the most common, noted in 67.8% of cases. subperiosteal or orbital abscess was recorded in 28.6% of the cases. Sinusitis was the most common etiology, found in 39.3% of cases. Treatment was based on empirical broad spectrum systemic antibiotics in all cases. Surgical management was performed in 39.3% of cases. Bacteriological samples were obtained for 28.5% of patients, with Staphylococcus aureus the most frequently isolated pathogen (5 cases; 62.5%). The evolution was favorable with complete resolution without sequelae in 92.8% of the cases and improvement of visual acuity in 82% of cases. Causes of poor visual outcome were corneal perforation, cataract and retinal detachment.
Conclusions: In our series, OI affects children and young adults. Their prognosis is generally favorable provided rapid and appropriate management.
Keywords:
Orbital infections ; Preseptal cellulitis ; Orbital cellulitis; Sinusitis ; Classification; Cranio-orbital computed tomography scan, Antimicrobial therapy##plugins.themes.academic_pro.article.details##
References
- Chaudhry IA, Al-Rashed W, Arat YO. The hot orbit: orbital cellulitis. Middle East Afr J Ophthalmol. 2012;19:34-42.
- Chandler JR, Langenbrunner DJ, Stevens ER. The pathogenesis of orbital complications in acute sinusitis. Laryngoscope 1970;80:1414-28.
- Ali A, Kurien M, Mathews SS, Mathew J. Complications of acute infective rhino sinusitis: Experience from a developing country. Singapore Med J. 2005;46:540-3.
- Liu IT, Kao SC, Wang AG, Tsai CC, Liang CK, Hsu WM. Preseptal and Orbital Cellulitis: A 10-Year Review of Hospitalized Patients. J Chin Med Assoc. 2006;69:415-22
- Hornblass A, Herschorn BJ, Stern K, Grimes C. Orbital abscess. Surv Ophthalmol 1984;29:169-78.
- Chaudhry IA, Shamsi FA, Elzaridi E, Al-Rashed W, Al-Amri A, Al-Anezi F, Arat YO, Holck DE. Outcome of treated orbital cellulitis in a tertiary eye care center in the middle East. Ophthalmology. 2007;114:345-54.
- Ferguson MP, McNab AA. Current treatment and outcome in orbital cellulitis. Aust N Z J Ophthalmol 1999;27:375-9.
- Harris GJ. Subperiosteal abscess of the orbit: age as a factor in the bacteriology and response to treatment. Ophthalmology 1994;101:585- 95.
- Ben Simon GJ, Bush S, Selva D, McNab AA. Orbital cellulitis: a rare complication after orbital blowout fracture. Ophthalmology 2005;112:2030-4
- Pushker N, Tejwani LK, Bajaj MS, Khurana S, Velpandian T, Chandra M. Role of oral corticosteroids in orbital cellulitis. Am J Ophthalmol. 2013 Jul;156:178-183.e1.
- Chen SC, Playford EG, Sorrell TC. Antifungal therapy in invasive fungal infections. Curr Opin Pharmacol. 2010;10:522-30.
- Patt BS, Manning SC. Blindness resulting from orbital complications of sinusitis. Otolaryngol Head Neck Surg 1991;104:789-95.