Orbital inflammation

orbital inflammation

1. ORBITAL INFLAMMATIONORBITAL INFLAMMATION
DR. Christina samuel

2. 
Pre-Septal cellulitisPre-Septal cellulitis

Orbital cellulitisOrbital cellulitis

Cavernous sinus Cavernous sinus
ThrombosisThrombosis

3. 
A] preseptal cellulitis B] orbital cellulitisA] preseptal cellulitis B] orbital cellulitis
C] subperiosteal abscess D] orbital abscessC] subperiosteal abscess D] orbital abscess
E] cavernous sinus thrombosisE] cavernous sinus thrombosis

4. 1.1.Preseptal cellulitisPreseptal cellulitis ::– inflammation – inflammation
involves structures anterior to the involves structures anterior to the
orbital septum.orbital septum.
2. 2. Orbital cellulitis:Orbital cellulitis: the inflammation the inflammation
is behind the orbital septum which is behind the orbital septum which
may or may not spill over the lidsmay or may not spill over the lids

6. Preseptal cellulitisPreseptal cellulitis
Symptoms & signs:Symptoms & signs:

Swelling, erythema, Swelling, erythema,
chemosis of lids chemosis of lids

Conjuntival discharge Conjuntival discharge

No proptosis, ocular No proptosis, ocular
movements movements

Vision not affected Vision not affected
Treatment:Treatment:

Antibiotics, NSAIDAntibiotics, NSAID

7. Orbital cellulitisOrbital cellulitis
Def: Purulent inflammation of the cellular tissue
of the orbit.
Cause:
-Spread of inflammation from neighboring parts –
nasal sinuses, Dacryocystitis, dental infection,
deep injuries, retained foreign body,
-septic operations, DCR, RD, SQUINT
-posterior extension of suppurative infection of eye
lid, panophthalmitis, facial erysipelas,
- Metastases in pyaemia

8. Causative organismsCausative organisms
Streptococcus pneumoniae. Streptococcus pneumoniae.
Staphylococcus aureusStaphylococcus aureus
Streptococcus pyogenesStreptococcus pyogenes
Haemophilus influenzae. (children below 5 years)Haemophilus influenzae. (children below 5 years)

9. Clinical featuresClinical features
1.1.Swelling, erythema, warmth, pain, tendernes of Swelling, erythema, warmth, pain, tendernes of
the lid the lid
2.2.Orbital abscess pointing on the skin or Orbital abscess pointing on the skin or
conjunctivaconjunctiva

10. 3.3.Proptosis – lateral Proptosis – lateral
and down and down
4.4.Restriction and pain Restriction and pain
of ocular movementsof ocular movements
5.5.Diplopia Diplopia
6.6.Afferent pupillary Afferent pupillary
defect defect
7.7.Diminished vision Diminished vision
due to compression due to compression
of optic nerve, its of optic nerve, its
blood supply, optic blood supply, optic
neuritisneuritis

11. ComplicationsComplications
1.1.Periorbital abscess Periorbital abscess
2.2.Exposure keratopathy Exposure keratopathy
3.3.C.R.A and C.R.V occlusion C.R.A and C.R.V occlusion
4.4.Panophthalmitis Panophthalmitis
5.5.Intracranial complications Intracranial complications
- meningitis, brain abscess, - meningitis, brain abscess,
- Cavernous Sinus thrombosis - Cavernous Sinus thrombosis

12. InvestigationsInvestigations
1.1.T.C.D.C,ESR T.C.D.C,ESR
2.2.CT orbit, sinus, brain CT orbit, sinus, brain
3.3.Blood, nasal, conjunctival and Blood, nasal, conjunctival and
throat culture and sensitivitythroat culture and sensitivity

13. TreatmentTreatment
1.1.Broad spectrum antibiotic Broad spectrum antibiotic
2.2.N.S.A.I.DN.S.A.I.D
3.3.Steroids Steroids
4.4.Close monitoring by ophthalmologist, neuro Close monitoring by ophthalmologist, neuro
surgeon, ENT surgeon surgeon, ENT surgeon
5.5.Surgical – drainage of the abscess, biopsy, Surgical – drainage of the abscess, biopsy,
orbital decompressionorbital decompression..

14. Cavernous Sinus Thrombosis Cavernous Sinus Thrombosis

Infection and thrombosis from the face, Infection and thrombosis from the face,
orbit, mouth, pharynx, ear, nose and orbit, mouth, pharynx, ear, nose and
sinuses can spread to the cavernous sinussinuses can spread to the cavernous sinus

The superior ophthalmic vein connects the facial The superior ophthalmic vein connects the facial
veins to the cavernous sinusveins to the cavernous sinus

One branch of the inferior ophthalmic vein connects One branch of the inferior ophthalmic vein connects
the orbit with that of the cavernous sinus.the orbit with that of the cavernous sinus.

The sinus of the one side communicates with the other The sinus of the one side communicates with the other
sideside

The whole venous system in this area is devoid of The whole venous system in this area is devoid of
valves.valves.

16. Clinical features Clinical features

Swelling of the lids and chemosis Swelling of the lids and chemosis

Proptosis, impaired motility Proptosis, impaired motility

Pain, diplopia, fever, headache, altered Pain, diplopia, fever, headache, altered
sensorium, rigors, vomiting, severe cerebral sensorium, rigors, vomiting, severe cerebral
symptoms symptoms

17. 
the fellow eye is affected in 50% of cases the fellow eye is affected in 50% of cases

Papilledema and involvement of the orbital veins are Papilledema and involvement of the orbital veins are
common in cases of otitis media and meningitis and common in cases of otitis media and meningitis and
cerebral abscesscerebral abscess

Edema in the mastoid region behind the ear indicates Edema in the mastoid region behind the ear indicates
thrombosis of the emissary veinsthrombosis of the emissary veins

18. Clinical features –cont.,Clinical features –cont.,

Severe supra orbital pain Severe supra orbital pain
-due to involvement of -due to involvement of
ophthalmic division of ophthalmic division of
the trigeminal nervethe trigeminal nerve

paralysis of the opposite paralysis of the opposite
lateral rectus is the first lateral rectus is the first
sign of spread(VI nerve)sign of spread(VI nerve)

Paresis of Paresis of
oculomotor(III) nervesoculomotor(III) nerves

Late stages the eye is Late stages the eye is
immobile ,pupil is not immobile ,pupil is not
acting and cornea is acting and cornea is
anaesthetised(V nerve)anaesthetised(V nerve)

19. TreatmentTreatment

Intra venous broad spectrum antibioticsIntra venous broad spectrum antibiotics

Anti coagulantsAnti coagulants

Treatment of the cause if it is knownTreatment of the cause if it is known

Steroids if there is no contra indicationsSteroids if there is no contra indications

A team effort of neurologists ,ENT specialists A team effort of neurologists ,ENT specialists
and ophthalmologists are neededand ophthalmologists are needed

20. Thank youThank you