SUMMARY Forty-nine cases of orbital cellulitis were reviewed. The average age of patients at presentation was 31 years. The onset of symptoms varied from seven days or less in 28 patients, one to four weeks in 17 patients, and more than four weeks in four patients. The Orbital cellulitis is an uncommon, potentially lethal disease. Prior to the discovery of antibiotics mortality rates of 20% to 50%, and blindness in 20% to 55% of the survivors, were reported.'2 Although improvement since that time has been dramatic, several series have recorded significant morbidity and mortality despite the use of antibiotics."'6 A review of 49 patients with orbital cellulitis seen in the Orbital Clinic at Moorfields Eye Hospital during a 13-year period demonstrates the advantages of giving appropriate antibiotics by the intramuscular or intravenous route. There were no deaths in this series, and damage to structures within the orbit was infrequent. Patients and methodsThe clinical records of all patients with a diagnosis of orbital cellulitis between 1970 and 1983 were reviewed. Forty-nine patients (24 male, 25 female) composed the study group. Patients were included only if they had postseptal orbital inflammation considered to be caused by bacteria, if pus was drained from the orbit, or prompt resolution of the signs and symptoms followed antibiotic therapy. Patients ranged in age from 4 weeks to 71 years, mean age 31 years. Ten patients were aged 14 years or less.All patients had radiographs of the skull, with under-tilted occipito-mental and oblique radiographs 174showing details of the paranasal sinuses. In a few patients axial hypocycloidal tomograms were obtained to reveal the anatomy of the ethmoid and sphenoid sinuses. Towards the end of the review period computed tomography (CT) scans were also obtained in selected patients.The patients were treated with a wide range of antibiotics. Those most commonly used were penicillin, synthetic penicillins effective against penicillinase-producing bacteria, ampicillin, amoxicillin, and chloramphenicol. These antibiotics were used alone or in combination, in large doses, and administered parenterally. Rifampin, ethambutol, and isoniazid were used to treat two patients who had tuberculous infections of the orbit.Surgical drainage was performed in patients who had clinical and radiological evidence of an orbital abscess. In a number of patients sinus drainage procedures were carried out, either during the infectious period or at a later date. We included this surgery in the results only if it was performed during the period of active orbital cellulitis.Follow-up data through complete resolution of the orbital cellulitis were available in all cases. ResultsThirty of the 49 patients with orbital cellulitis had left orbital involvement and 17 had right orbital involvement. In two cases the orbital cellulitis was bilateral.
Blepharochalasis is an uncommon disorder characterised by recurrent, non-painful, nonerythematous episodes of eyelid oedema. It must be distinguished from dermatochalasis, which is an involutional change of eyelids and is associated with loose, redundant skin.' Beer2 was the first to describe this entity in 1807, and Fuchs3 coined the term blepharochalasis in 1896. It has been divided into hypertrophic and atrophic forms.45 In the hypertrophic form recurrent oedema results in orbital fat herniation through a weakened orbital septum. Most patients who have blepharochalasis present in an atrophic condition with atrophy of redundant eyelid skin and superior nasal fat pads. Most of these atrophic patients do not go through a hypertrophic phase.Multiple attacks of eyelid oedema result in thinning, stretching, and atrophy of eyelid tissues. The eyelid skin becomes redundant, discoloured, and atrophic, appearing like wrinkled cigarette paper. The upper eyelids are more commonly affected, but the lower eyelids may also be involved. Laxity of the lateral canthal tendon results in rounding of
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