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Survey of Ophthalmology 2018Orbital cellulitis (OC) is an inflammatory process that involves the tissues located posterior to the orbital septum within the bony orbit, but the term generally is... (Review)
Review
Orbital cellulitis (OC) is an inflammatory process that involves the tissues located posterior to the orbital septum within the bony orbit, but the term generally is used to describe infectious inflammation. It manifests with erythema and edema of the eyelids, vision loss, fever, headache, proptosis, chemosis, and diplopia. OC usually originates from sinus infection, infection of the eyelids or face, and even hematogenous spread from distant locations. OC is an uncommon condition that can affect all age groups but is more frequent in the pediatric population. Morbidity and mortality associated with the condition have declined with advances in diagnostic and therapeutic options; however, OC can still lead to serious sight- and life-threatening complications in the modern antibiotics era. Therefore, prompt diagnosis and treatment remain crucial. Antibiotic coverage, computed tomography imaging, and surgical intervention when needed have benefitted patients and changed the disease prognosis. We review the worldwide characteristics of OC, predisposing factors, current evaluation strategies, and management of the disease.
Topics: Anti-Bacterial Agents; Diagnosis, Differential; Diagnostic Techniques, Ophthalmological; Eye Infections, Bacterial; Humans; Ophthalmologic Surgical Procedures; Orbital Cellulitis; Prognosis; Risk Factors
PubMed: 29248536
DOI: 10.1016/j.survophthal.2017.12.001 -
International Journal of Pediatric... Jul 2018Orbital complications account for 74-85% of all complications from acute sinusitis, more often affect the pediatric population, and can result in devastating... (Review)
Review
OBJECTIVES
Orbital complications account for 74-85% of all complications from acute sinusitis, more often affect the pediatric population, and can result in devastating consequences. Therefore these patients require prompt diagnosis and proper management. We review and summarize the current literature to determine the appropriate management of each stage of pediatric orbital cellulitis and offer a new comprehensive literature-based algorithm.
METHODS
Data sources were PubMed/MEDLINE, and Google Scholar. Studies relevant to the management of each subcategory of the Chandler criteria in the pediatric population, limited to the period 1997 through Jan 2018, were compiled and interpreted. Seventy-one studies were reviewed in total.
RESULTS
Pre-septal and post-septal cellulitis can generally be managed non-surgically, while orbital abscess and cavernous sinus thrombosis are managed surgically. For subperiosteal abscess, non-surgical medical management has been successful in certain patients. Results of the literature review were summarized, and subsequently developed into a comprehensive algorithm for management, including criteria for age, location, and volume of abscess on imaging.
CONCLUSIONS
Orbital cellulitis, particularly subperiosteal abscesses, in children is not an absolute indication for immediate surgical intervention. Conservative measures can be safe and effective if appropriately used, depending on patient characteristics, clinical course, and imaging.
Topics: Abscess; Acute Disease; Adolescent; Age Factors; Algorithms; Anti-Bacterial Agents; Cavernous Sinus Thrombosis; Child; Child, Preschool; Female; Humans; Male; Orbital Cellulitis; Sinusitis
PubMed: 29859573
DOI: 10.1016/j.ijporl.2018.05.006 -
Indian Journal of Ophthalmology Jul 2023Infections of orbit and periorbita are frequent, leading to significant morbidity. Orbital cellulitis is more common in children and young adults. At any age, infection... (Review)
Review
Infections of orbit and periorbita are frequent, leading to significant morbidity. Orbital cellulitis is more common in children and young adults. At any age, infection from the neighboring ethmoid sinuses is a likely cause and is thought to result from anatomical characteristics like thin medial wall, lack of lymphatics, orbital foramina, and septic thrombophlebitis of the valveless veins between the two. Other causes are trauma, orbital foreign bodies, preexisting dental infections, dental procedures, maxillofacial surgeries, Open Reduction and Internal Fixation (ORIF), and retinal buckling procedures. The septum is a natural barrier to the passage of microorganisms. Orbital infections are caused by Gram-positive, Gram-negative organisms and anaerobes in adults and in children, usually by Staphylococcus aureus or Streptococcus species. Individuals older than 15 years of age are more likely to harbor polymicrobial infections. Signs include diffuse lid edema with or without erythema, chemosis, proptosis, and ophthalmoplegia. It is an ocular emergency requiring admission, intravenous antibiotics, and sometimes surgical intervention. Computed tomography (CT) and magnetic resonance imaging (MRI) are the main modalities to identify the extent, route of spread from adjacent structures, and poor response to intravenous antibiotics and to confirm the presence of complications. If orbital cellulitis is secondary to sinus infection, drainage of pus and establishment of ventilation to the sinus are imperative. Loss of vision can occur due to orbital abscess, cavernous sinus thrombosis, optic neuritis, central retinal artery occlusion, and exposure keratopathy, and possible systemic sequelae include meningitis, intracranial abscess, osteomyelitis, and death. The article was written by authors after a thorough literature search in the PubMed-indexed journals.
Topics: Child; Young Adult; Humans; Orbital Cellulitis; Abscess; Orbit; Exophthalmos; Anti-Bacterial Agents
PubMed: 37417106
DOI: 10.4103/IJO.IJO_3283_22 -
Journal of the Pediatric Infectious... May 2022The epidemiology of orbital cellulitis likely has evolved due to the emergence of methicillin-resistant Staphylococcus aureus (MRSA) and the adoption of pneumococcal... (Review)
Review
BACKGROUND
The epidemiology of orbital cellulitis likely has evolved due to the emergence of methicillin-resistant Staphylococcus aureus (MRSA) and the adoption of pneumococcal conjugate vaccination. In the absence of published guidelines, management is highly variable. We characterized epidemiology and management over an 11-year period.
METHODS
A retrospective cohort study of children 0 to 21 years of age with orbital cellulitis +/- subperiosteal orbital abscess hospitalized at a large quaternary children's hospital from January 2008 to June 2018. We reviewed charts for demographic characteristics, clinical features, management, and outcomes. Using multivariable logistic regression, we evaluated predictors of surgical intervention and assessed whether corticosteroid use or antibiotic duration was related to clinical outcomes.
RESULTS
Among 220 patients, methicillin-susceptible S. aureus was the most common organism (26.3%), with MRSA found in only 5.0%. Rates of vancomycin use fluctuated annually from 40.9% to 84.6%. Surgery was performed in 39.5% of the patients. Corticosteroids, used in 70 patients (32.1%), were unrelated to treatment failure (n = 9), defined as persistent signs and symptoms or initial clinical improvement followed by worsening (P = .137). The median antibiotic duration was 17 days (interquartile range 14-26). After controlling for age, gender, proptosis, eye pain with movement, eyelid swelling, neutrophil count, and corticosteroid use, treatment failure was not significantly associated with receipt of ≥ 3 weeks of antibiotic therapy (8/84, 9.5%) compared with > 2 but < 3 weeks (0/51, 0.0%) or ≤ 2 weeks (1/85, 1.2%) (adjusted odds ratio = 5.83 for ≥ 3 vs ≤2 weeks; 95% confidence interval: 0.58, 59.0).
CONCLUSIONS
Although MRSA was rare, empiric vancomycin use was high. Treatment failure was uncommon in patients who received ≤ 2 weeks of therapy, suggesting that shorter durations are adequate in some patients.
Topics: Abscess; Adrenal Cortex Hormones; Anti-Bacterial Agents; Child; Humans; Infant, Newborn; Methicillin-Resistant Staphylococcus aureus; Orbital Cellulitis; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Vancomycin
PubMed: 35438766
DOI: 10.1093/jpids/piac006 -
JAMA Jan 2020
Topics: Administration, Intravenous; Anti-Bacterial Agents; Cellulitis; Diagnosis, Differential; Eye Infections, Bacterial; Humans; Orbital Cellulitis
PubMed: 31935029
DOI: 10.1001/jama.2019.18211 -
Deutsches Arzteblatt International Jan 2020
Topics: Adolescent; Humans; Male; Orbital Cellulitis
PubMed: 32036856
DOI: 10.3238/arztebl.2020.060b -
The American Journal of Emergency... Jun 2023Orbital cellulitis is an uncommon but serious condition that carries with it a potential for significant morbidity. (Review)
Review
INTRODUCTION
Orbital cellulitis is an uncommon but serious condition that carries with it a potential for significant morbidity.
OBJECTIVE
This review highlights the pearls and pitfalls of orbital cellulitis, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.
DISCUSSION
Orbital cellulitis refers to infection of the globe and surrounding soft tissues posterior to the orbital septum. Orbital cellulitis is typically caused by local spread from sinusitis but can also be caused by local trauma or dental infection. It is more common in pediatric patients compared to adults. Emergency clinicians should first assess for and manage other critical, sight-threatening complications such as orbital compartment syndrome (OCS). Following this assessment, a focused eye examination is necessary. Though orbital cellulitis is primarily a clinical diagnosis, computed tomography (CT) of the brain and orbits with and without contrast is critical for evaluation of complications such as abscess or intracranial extension. Magnetic resonance imaging (MRI) of the brain and orbits with and without contrast should be performed in cases of suspected orbital cellulitis in which CT is non-diagnostic. While point-of-care ultrasound (POCUS) may be useful in differentiating preseptal from orbital cellulitis, it cannot exclude intracranial extension of infection. Management includes early administration of broad-spectrum antibiotics and ophthalmology consultation. The use of steroids is controversial. In cases of intracranial extension of infection (e.g., cavernous sinus thrombosis, abscess, or meningitis), neurosurgery should be consulted.
CONCLUSION
An understanding of orbital cellulitis can assist emergency clinicians in diagnosing and managing this sight-threatening infectious process.
Topics: Adult; Child; Humans; Orbital Cellulitis; Abscess; Prevalence; Orbit; Ophthalmology; Anti-Bacterial Agents; Cellulitis; Orbital Diseases; Retrospective Studies
PubMed: 36893591
DOI: 10.1016/j.ajem.2023.02.024 -
Disease-a-month : DM Feb 2017
Review
Topics: Anti-Bacterial Agents; Eyelid Diseases; Humans; Orbital Cellulitis
PubMed: 27884386
DOI: 10.1016/j.disamonth.2016.09.002 -
Journal Francais D'ophtalmologie Jan 2012Orbital cellulitis is uncommon in ophthalmologic practice. The majority of cases arise from direct spread of sinus infection or eyelid infection. Clinically, orbital... (Review)
Review
Orbital cellulitis is uncommon in ophthalmologic practice. The majority of cases arise from direct spread of sinus infection or eyelid infection. Clinically, orbital cellulitis is divided into two forms: the preseptal form, anterior to the orbital septum, and the retroseptal form, posterior to the orbital septum. Management and prognosis differ widely between the two types. The retroseptal form or "true" orbital cellulitis is a severe disease with potentially disastrous consequences for vision and survival. Clinical examination and urgent CT scanning are indispensable for correct diagnosis, evaluation of severity, surgical planning and antibiotic selection.
Topics: Abscess; Diagnostic Techniques, Ophthalmological; Edema; Humans; Models, Biological; Ophthalmologic Surgical Procedures; Orbital Cellulitis; Orbital Diseases; Sinus Thrombosis, Intracranial
PubMed: 22221713
DOI: 10.1016/j.jfo.2011.08.004 -
Clinical Pediatrics Sep 2022
Topics: Anti-Bacterial Agents; Cellulitis; Humans; Orbital Cellulitis; Retrospective Studies
PubMed: 35470703
DOI: 10.1177/00099228221093858