Orbital cellulitis — treatment, symptoms

Orbital cellulitis (phlegmon of the orbit), is a rare but dangerous disease. If a patient is not provided in a timely manner, then it is a direct threat to his life. At the venous channel of the orbit may spread purulent process, which causes complications such as meningitis or thrombosis of cerebral vessels. In 20% of cases they lead to death of the patient. Most often, the disease affects children under 5 years.

What it is

Orbital cellulitis is an inflammatory process resulting from infection in the orbit and affecting the tissue behind the orbital septum.

The illness develops very quickly and is accompanied by phenomena of intoxication. Yourself to get rid of him fail. You should immediately seek medical help.

Reasons

Cause orbital cellulitis are bacterial infections. Most often disease causing bacteria, such as:

  • Staphylococcus aureus;
  • pneumococcus;
  • Streptococcus;
  • diplococci;
  • Escherichia coli.

Trigger orbital cellulitis following pathology:

Injuries

  • tissue injuries of the orbit;
  • getting into the orbit of foreign bodies;
  • insect bites;
  • operations on the eyelids and paranasal cavities of the nose.

Purulent abscesses on the face

  1. purulent dacryocystitis;
  2. purulent sinusitis;
  3. boil;
  4. erysipelas;
  5. barley;
  6. the furunculosis.

Infectious diseases

  • flu;
  • fever;
  • scarlet fever;
  • puerperal sepsis.

Purulent processes

  1. subperiosteal abscesses;
  2. osteomyelitis of the upper jaw;
  3. periodontal abscess.

In 70% of cases, the cause of development of cellulite becomes orbital complication of sinusitis (in particular etmoidit).

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Symptoms of orbital cellulitis

The disease can develop over several hours, maximum 2 days. In most cases, it affects one eye and is manifested as the following symptoms:

  • starts to ache. Uncomfortable sensations with movement of the eye;
  • there is pain in the area of century and orbit. On palpation it becomes stronger;
  • the eyelids turn red, become swollen and tense, they are hard to open;
  • there icteric staining of the sclera;
  • there are growing signs of intoxication, the patient’s temperature rises, there is vomiting, lethargy;
  • with the development of diseases of the eye bulges and prejudiced swollen eyelids. This occurs because the mucous membrane as a result of swelling increases in size; and is placed in the conjunctival SAC;
  • as a result, the eye is fixed without movement, vision deteriorates;
  • between the guide eye and the edge of the orbit palpable swollen contents;
  • in the process you may lose the optic nerve. This can trigger the development of optic neuritis and retinal vein thrombosis;
  • such trophic disorders as suppurative keratitis or ulcer can occur when the nerve entrapment;
  • if the disease gives complication on the retina occurs purulent panophthalmitis or horioidita, which subsequently leads to atrophy of the eye;
  • if the process is restricted, in the orbit may form an abscess, which in some cases is revealed spontaneously. The contents flows through the conjunctiva or skin. In this case, the formation of poorly healing of the fistula.

Complications

Timely begun treatment the prognosis is favorable.

The disease can cause the following complications:

  • meningitis;
  • blood poisoning;
  • cavernous sinus thrombosis;
  • hearing loss;
  • blurred vision.

In the long term may occur:

  1. a thorn,
  2. strabismus,
  3. amblyopia,
  4. atrophy of the optic nerve.

Diagnosis

To diagnose the disease can ophthalmologist after visual inspection and medical history. Also the patient should consult a dentist, otolaryngologist and infectious disease.

Blood is not always informative, because the number of leukocytes may be normal.

If you are sure that it is orbital cellulitis is it possible to conduct magnetic resonance or computed tomography. If you suspect the presence of cavernous sinus thrombosis is a preference for MRI.

In the differential diagnosis the disease must be distinguished from the following pathologies:

  • pseudotumor of the orbit;
  • prenatally cellulite;
  • fikomikoz;
  • orbital abscess;
  • metastatic lesion.

It is also necessary to perform x-rays of the sinuses and orbit. The will help to make a differential diagnosis and exclude the presence in the eye foreign body.

If you suspect meningitis perform a lumbar puncture. And in that case, if there is a suspicion of sinusitis doing the sowing discharge from the sinuses.

The infection may indicate the direction of the ptosis. If the source of infection is from the ethmoid labyrinth, the protrusion of the eyeball takes place at the side and outwards. But if it is from the frontal sinus, the eye bulges downward and outward.

Treatment

Treatment of orbital cellulitis is conducted in ophthalmology departments under the supervision of medical staff.

For the treatment of severe forms of the disease, use of antibiotics:

  • if the cause of the disease was eye injury or contact with foreign bodies is prescribed therapy with antibiotics. It is directed against gram-positive and gram-negative microorganisms: Vancomycin 1 g intravenously twice a day, Ertapenem 100 mg intravenously once a day. The duration of treatment is from seven to ten days;
  • in the presence of sinusitis treatment is with antibiotics from the cephalosporin group 2 or 3 generations. Drugs (Ceftriaxone, Cefotaxime) are administered intravenously every 6 or 12 hours.

The choice of drug for treatment of the disease and the dosage is determined by your doctor depending on the patient’s age and severity of the disease. In most cases, are assigned a maximum dose of medication.

For the treatment of orbital cellulitis, can be assigned the following drugs.

  • Streptomycin 500 000 IU twice a day;
  • Tetracycline tablets 250 mg, in combination with Nystatin 100 mg twice a day;
  • Sulfapiridazin 500 mg. during the first days appoint a maximum of four tablets, in the future, reduce the dose;
  • Gentamicin twice a day;
  • Benzylpenicillin 500,000 UNITS four times per day.

In order to reduce the toxicity injected intravenously 40% glucose and ascorbic acid.

Treatment continued for 2 weeks. Intravenous use Hexamethylenetetramine 40%, 10 ml.

Can also be prescribed eye drops with antibiotic (Normaks, Not Cipromed) and vitamin solutions conjunctival.

It is not recommended to apply hot wet compresses, because it can facilitate the spread of infection.

Surgery

If the cause of the disease is abscess of the sinuses and abscess of the jaw it is an immediate opening and drainage. If no effect is carried out the same procedure to eliminate abscesses of the orbit.

Indications for the drainage of abscess, autopsy of infected sinuses or surgical decompensation of the orbit are:

  • loss of visual acuity;
  • suspected abscess;
  • the suspected presence of a foreign body;
  • instrumental revealed orbital process;
  • the ineffectiveness of antibiotics.

The operation is performed under General or local anesthesia in the following way:

  • if you open a superficial abscess in the upper eyelid, tissue is cut through the center of mass of the infiltration. Dissection proishodjat in the upper inner or upper outer edge of the orbit. If the infiltration is localized in the region of the lower eyelid, use incisions along the inner lower or bottom outer edge of the orbit, deviating from it half a centimeter up or down;
  • if you reveal the deep process, the lower edge of the wound peeled from the periosteum;
  • To opening and drainage of deep process netscout the orbital septum in the place where it is attached to the upper edge of the orbit. By separation of fiber superior part of the orbit reveal the abscess. Further applying a hemostatic clamp, pass behind the eyeball.

After opening prescribed antiseptic treatment:

  • Sulfatsil sodium;
  • Rivanol, hydrogen Peroxide 3%;
  • Ichthyol, Camphor ointment;
  • Physiotherapy (Solux lamp).

In the early days make the dressing 2 – 3 times a day, and later once.

Recovery from the disease

In the future, to restore vision and prevention of late complications can be assigned to the additional use of vitamin complexes:

  • Striks;
  • Vitrum Vision;
  • Kuwait Lutein;
  • Bilberry Forte.

Prevention

In order to prevent disease should:

  • time to go to the doctor for the treatment of diseases of ENT-organs; in particular sinusitis, ethmoiditis, sinusitis;
  • when hit in the eye foreign bodies requires the use of antibiotics;
  • you should regularly visit the dentist to eliminate dental diseases;
  • in the presence of purulent diseases of the face should consult a dermatologist and time to start treatment.

At the first sign of the disease should consult a doctor. In some cases, quick treatment can save patient’s life.

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