Diagnosis and Management of Orbital Cellulitis


Imtiaz A. Chaudhry, Waleed Al-Rashed, Osama Al-Sheikh and Yonca O. Arat






Orbital cellulites is an uncommon infectious process in which patient may present with pain, reduced visual acuity, compromised ocular motility and significant proptosis. [1]- [3] In the modern era of relatively early access to the health care facilities, complete loss of vision from orbital cellulitis is rare. In the vast majority of cases, a history of upper respiratory tract infection prior to the onset is very common especially in children. [4], [5] Chandler et al, [6] for simplicity has classified the disease into 5 categories and emphasized the possibility of fatal outcome due to the extension of the abscess to cavernous sinus in the form of thrombosis and intracranial spread. In addition to the loss of vision, orbital cellulitis can be associated with a number of other serious complications that may include intracranial complications in the form of cavernous sinus thrombosis, meningitis, frontal abscess and even death. Historically, since the wide spread use of effective antibiotics, the serious complications of orbital cellulitis have become much less frequent. In the past, loss of vision was a relatively more common outcome of orbital cellulitis. [2] In the recent years, only few case reports of loss of vision following orbital cellulitis has been reported in the literature. For example, Connel et al, [3] reported case of a 69-year-old man who presented with no light perception vision, proptosis and significant ophthalmoplegia. In their case, despite emergent drainage of the abscess and systemic antibiotics, no improvement in vision was noted despite the return of the full ocular motility and disappearance of proptosis. Connel et al, [3] postulated Streptococcal-related ischemic necrosis of the optic nerve as a possible mechanism of loss of vision in their patient. In one of the recent survey of 52 patients treated for orbital cellulitis, over 35% had decreased vision and on their last follow-up, only 4% had decreased visual acuity. [1] Our own experience in treating 218 patients with orbital complications of cellulitis revealed that visual acuity improved in 16.1% and worsened in 6.2%, including 4.3% that sustained complete loss of vision. [8] We attributed the permanent loss of vision to the delay in diagnosis and intervention. Further, there were 9 cases of intracranial orbital abscess extension that required either extended treatment with systemic antibiotics alone or in combination with neurosurgical intervention. [3]