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.
Orbital infections represent more than half of primary orbital disease processes 2.
- painful ophthalmoplegia
- 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.
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.
Diffuse soft-tissue thickening and areas of enhancement anterior to the orbital septum are seen on periorbital 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
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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.
- 1. Lebedis CA, Sakai O. Nontraumatic orbital conditions: diagnosis with CT and MR imaging in the emergent setting. Radiographics. 2008;28 (6): 1741-53. doi:10.1148/rg.286085515 - Pubmed citation
- 2. Capps EF, Kinsella JJ, Gupta M et-al. Emergency imaging assessment of acute, nontraumatic conditions of the head and neck. Radiographics. 2010;30 (5): 1335-52. doi:10.1148/rg.305105040 - Pubmed citation
- 3. Sepahdari AR, Aakalu VK, Kapur R et-al. MRI of orbital cellulitis and orbital abscess: the role of diffusion-weighted imaging. AJR Am J Roentgenol. 2009;193 (3): W244-50. doi:10.2214/AJR.08.1838 - Pubmed citation
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