Managment of orbital complications of sinusitis

Abstract

Approval of the research ethics committee: Dicle University Medical Faculty Ethics Committee for Noninterventional Studies-2014/139. ABSTRACT Purpose:We reported on the clinical approaches of ophthalmology and otorhinolaryngology departments in the treatment of the orbital complications of sinusitis. We also included an in-depth literature review. Methods: We retrospectively reviewed the medical files of 51 patients from January 2008 to January 2014. The records were evaluated for age, gender, type of orbital complications, symptoms, predisposing factors, imaging studies, medical and surgical management, culture results, and follow-up information. SPSS version 15.0 software (Statistical Analysis, The Statistical Package for Social Sciences Inc, Chicago, IL) was used for the statistical analysis. Results: Fifty-one patients met the criteria, with available medical records, for the study (29 male, 22 female). Thirty-two (62.7%) were diagnosed with preseptal cellulitis and 19 (37.3%) with postseptal cellulitis. After a detailed evaluation, 15 were diagnosed with a subperiosteal abscess (SPA), and 4 were diagnosed with orbital cellulitis. The age and gender was similar for the two groups. Five patients with medial SPA were treated with endoscopic sinus surgery, one patient with inferior SPA was treated with external surgery, and six patients with other localizations were treated with a combination of endoscopic sinus surgery and external surgery. All patients presented with periorbital erythema and edema. The length of hospitalization and duration of symptoms were similar in both groups. Visual acuity was between 1/10 to 10/10 (mean 7/10) and statistically significant for preseptal and postseptal cellulitis groups (p<0.001). All patients received intravenous antibiotics upon the first day of admission. Conclusion: Orbital complications of acute sinusitis required intensive follow-up and a multidisciplinary approach. A contrast-enhanced paranasal sinus computerized tomography (CT) scan can detect the extent of the infection. An initial trial of intravenosus (IV) antibiotics may be appropriate when close monitoring is possible. Surgery may be indicated when there has been no improvement within 48 hours of intravenous treatment, loss of visual acuity (under 8/10), and a non-medial abscess.

Oculo Orbital Complications of Sinusitis

“…Some germs seem to present a significant aggressiveness as evidenced by the rapid evolution towards complications. However, the increasing resistances to antibiotic treatment in the first intention must be evoked primarily [3] [14] [15]. For certain authors, the staphylococcus aureus, the streptococcus, anaerobes are most often responsible for orbital complications [21] [22].…”

“…This treatment must be adapted secondly in terms of bacteriological results [3] [6] [25] [26]. The duration of intravenous antibiotic therapy is from 5 to 10 days with oral relay soon as apyrexia is durable, and after the disappearance of local inflammatory signs, and it must last between 10 and 15 days [15] [24] [26].…”

“…A randomized clinical attempt confirmed without ambiguity, the benefit of aspirin on the vital and the functional prognosis of the patient. Even in case of the presence of cerebral hemorrhagic lesions [15].…”

“…The surgical orbital drainage, using a bacteriological examination, is indicated before tomodensitometric examination of an orbital collection or before the clinical aggravation under treatment [6] [15]. It must be per-formed in urgency, in order to avoid having serious complications, such as optic nerve compression or of the cavernous sinus thrombosis [12] [28].…”

“…It often helps ameliorating drainage and ventilation of the cells of anterior ethmoid, eliminating the inflammatory pathology which causes the obstruction of drainage tract [5] [15]. The surgical drainage allows having, in good conditions, often difficult bacteriological samples, or impossible to perform in consultation, to open the sinuses widely, and to wash, and to drain.…”