Non-medial infectious orbital cellulitis: etiology, causative organisms, radiologic findings, management and complications

Abstract

Background: Orbital cellulitis is an ophthalmic emergency, which is associated with vision-threatening adverse effects. The purpose of this study is investigating etiology, radiologic findings, management and complications of patients with non-medial orbital cellulitis. Method: A retrospective medical record and radiologic file review of patients with infectious orbital cellulitis was performed to detect all patients with non-medial orbital cellulitis who referred to Khalili hospital from 2016 to 2019. Age, sex, origin of infection, size of collection or abscess, medical or surgical management, microbiology, first and final best-corrected visual acuity, duration of admission, and complications was recorded. Patients divided into two groups; medical management and surgical management groups and all of data compared between in this groups. Results: Of ninety-six patients with infectious orbital cellulitis, 23 cases (14 male, 9 female) were included. Five patients (21.7%) were managed medically and 18 patients (78.3%) were managed surgically. Patients' age range was 5-70 years old. Most common location for non-medial cellulitis was superior space (66.7% in surgical and 40% in medical group; p = 0.511). In 13 cases of surgical group (72.3%) were detected microorganisms. The mean ± SD of collection volume in medical group were 476.5 ± 290.93 mm 3 and 2572.94 ± 1075.75 mm 3 in surgical group (p < 0.001). Ten patients in surgical group had compressive optic neuropathy. The mean ± SD of collection volume was 3204.97 ± 879.88 mm 3 in patient with compressive optic neuropathy and 1280.43 ± 880.68 mm 3 in patient without compressive optic neuropathy (P < 0.001). One case complicated by subdural empyema and another case progressed to necrotizing fasciitis. Conclusion: Non-medial orbital cellulitis is an uncommon but sight-threatening and life-threatening condition. Timely diagnosis and accurate management reduce morbidity and mortality. Combined surgery for patients with superior or supra-temporal and large non-medial abscess is recommended.

Non-medial Subperiosteal Abscess in a 63-Year-Old Female: A Case Report and Literature Review

“…Clinical manifestations typically observed in patients with orbital cellulitis include eyelid swelling, dull and persistent orbital pain, erythema, tenderness, chemosis, restricted ocular motility, and proptosis [ 2 , 7 , 8 ]. In line with this, our case exhibited eyelid swelling, escalating pain, proptosis, diminished vision, and limited ocular movement, in conjunction with opacified bilateral paranasal sinuses indicative of orbital cellulitis secondary to paranasal sinusitis.…”

“…In line with this, our case exhibited eyelid swelling, escalating pain, proptosis, diminished vision, and limited ocular movement, in conjunction with opacified bilateral paranasal sinuses indicative of orbital cellulitis secondary to paranasal sinusitis. Documented complications of orbital cellulitis include subperiosteal abscess, prolonged proptosis leading to corneal exposure and ulceration, optic neuropathy due to neuritis, panophthalmitis, and intracranial issues such as cavernous sinus thrombosis and meningitis [ 2 , 7 ]. Chandler et al were the first to divide the illness into five phases, indicating the morbidity and severity of each (Table 3 ) [ 9 ].…”

“…This predilection is attributed to the ethmoidal sinus’s fragile bone structure. While non-medial orbital cellulitis presentations are infrequent, they are deemed as potential sight and life-threatening conditions [ 2 , 5 , 7 ].…”

“…In a study by Abtahi et al, it was found that 65.2% of patients with non-medial orbital cellulitis identified sinusitis and pansinusitis as the predominant sources of their condition, with the front-ethmoid sinuses being the most frequently affected [ 7 ]. In concordance with their findings, our case similarly exhibited superior collection coupled with bilateral pan-paranasal sinus involvement and opacification of the frontal sinus.…”

A rare case of microblading-induced preseptal cellulitis

“…To diagnose preseptal cellulitis, clinical signs of orbital involvement, such as proptosis, diminished visual acuity, painful eye movement, and ophthalmoplegia with diplopia must be excluded. 5 If the uncertainty of the diagnosis remains or orbital cellulitis is suspected, computed tomography with contrast of the septum and orbits is indicated.…”