Text of Orbital Cellulitis Tal Marom, M.D. September 2004
Orbital CellulitisOrbital Cellulitis
Tal Marom, M.D.
Orbit anatomyOrbit anatomy
Orbital CellulitisOrbital CellulitisOrbital cellulitis is a dangerous infection with
potentially serious complicationsIt is usually caused by a bacterial infection from
the sinuses (mainly ethmoid, accounting for more than 90% of all cases)
Other causes :a stye on the eyelid, recent trauma to the eyelid including bug bites, or a foreign object
In children, orbital cellulitis is usually from a sinus infection and due to the organism Hemophilus influenzae (decrease in incidence after vaccination program implentation).
Other organisms are Staphlococcus aureus, Streptococcus pneumoniae, and Beta hemolytic streptococci
extension of infection from the periorbital structures, most commonly from the paranasal sinuses, but also from the face, globe, and lacrimal sac
direct inoculation of the orbit from trauma or surgery (orbital decompression, dacryocystorhinostomy, eyelid surgery, strabismus surgery, retinal surgery, and intraocular surgery, have been reported as the precipitating cause of orbital cellulitis)
hematogenous spread from bacteremia
Orbital septumOrbital septum
The orbit is separated from the soft tissue of the eyelid by the orbital septum. This is a fascial plane that is continuous with the periosteum of the facial bones.
The orbital septum inserts into the tarsal plate of the upper and lower eyelids.
The orbital septum usually proves to be an effective barrier that prevents the spread of infection from the eyelids posteriorly to the orbit.
While preseptal cellulitis can occasionally spread to the orbital contents, it is generally a clinical entity that is distinct from orbital cellulitis
Orbital septumOrbital septum
Orbital vs. Preseptal CellulitisOrbital vs. Preseptal Cellulitis
Orbital cellulitis is infection of the soft tissues of the orbit posterior to the orbital septum, differentiating it from preseptal cellulitis, which is infection of the soft tissue of the eyelids and periocular region anterior to the orbital septum
DD: orbital pseudotumor (inflammatory condition, responds to steroids)
Chandler ClassificationChandler Classification
Stage I Inflammatory edema-Preseptal
Stage II Orbital cellulitis - Postseptal
Stage III Subperiostal abscess
Stage IV Orbital abscess
Stage V Complication due to posterior extension
Fever, generally 102 degrees F or greater. Painful swelling of upper and lower lids (upper is usually
greater). Eyelid appears shiny and is red or purple in color. Infant or child is acutely ill or toxic. Eye pain especially with movement. Decreased vision (because the lid is swollen over the eye). Eye bulging (forward displacement of the eye). Swelling of the eyelids General malaise. Restricted or painful eye movements
Subperiostal/Orbital abscess (Chandler III-IV)Cavernous sinus thrombosis Hearing loss Septicemia or blood infection Meningitis Optic nerve damage and blindeness
A male with orbital cellulitis with proptosis, A male with orbital cellulitis with proptosis, ophthalmoplegia, and edema and erythema of the eyelidsophthalmoplegia, and edema and erythema of the eyelids
Lateral Orbit DecompressionLateral Orbit DecompressionLateral canthotomyRemoval of lateral orbital bone posterior to the
rimOrbital fat protrudes the newly created space
An incision extending from the lateral canthus to the area just below the inferior punctum is created 4 mm to 5 mm below the lower border of the tarsal plate to avoid injury to the septum and the canaliculus
Intranasal approachIntranasal approachDecompression of medial anf medioinferior
floors of orbitEndoscopic sinus surgery techniqueAnterior EthmoidectomyMaxillary antrostomy