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Orbital infection

Dr Yuranga Weerakkody and Dr Bruno Di Muzio et al.

Orbitial infection can be a commonly encoutered entity.

It is important to differentiate between orbital and periorbial cellulitis, as this has theraputic and prognostic implications:

peri-orbital cellulitis : also known as pre-septal cellulitis, is limited to the soft tissues anterior to the orbital septum¹. This condition is often managed with oral antibiotics.
orbital cellulitis : refers to a post-septal infection¹. This is a more serious condition requiring hospitalisation and parental antibiotics. Complications such as intraorbital abscess formation may require surgical intervention.

The orbital septum is a thin sheet of fibrous tissue that originates in the orbital periosteum and inserts in the palpebral tissues along the tarsal plates. The orbital septum provides a barrier against the spread of periorbital infections into the orbit proper ².

Epidemiology

Orbital infections represent more than half of primary orbital disease processes ².

Clinical presentation

proptosis
painful ophthalmoplegia
chemosis
reduced visual acuity

Periorbital cellulitis often results from contiguous spread of an infection of the face, teeth, or ocular adnexa. Orbital cellulitis typically results from extension of a paranasal sinusitis infection¹.

Radiographic features

Urgent imaging is indicated to assess the anatomic extent of disease, including postseptal, cavernous sinus, and intracranial involvement; evaluate for sources of contiguous spread, such as with sinusitis or trauma; and identify orbital abscesses that require exploration and drainage³.

CT

Periorbital cellulitis

Diffuse soft-tissue thickening and areas of enhancement anterior to the orbital septum are seen on periorbital cellulitis.

Orbital cellulitis

poor definition of orbital planes
inflammatory stranding in the intraconal fat
intraconal or extraconal soft tissue mass
oedema of the extraocular muscles
intraorbital abscess
subperiosteal abscess

MRI

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Complications

Complications of orbital cellulitis include superior ophthalmic vein thrombosis, cavernous sinus thrombosis, loss of vision, meningitis, and intracranial abscess¹.

Treatment and prognosis

Periorbital cellulitis is treated with oral antibiotic therapy. Orbital cellulitis is treated with intravenous antibiotic therapy; however, if a subperiosteal abscess is present, surgical drainage may be necessary¹.