Search

Objective This retrospective study evaluates the demographic characteristics, clinical symptoms, laboratory results, treatment approaches, and outcomes of children with complications arising from bacterial sinusitis. Methods Fifty-four pediatric inpatients with sinusitis complications admitted between September 2013 and October 2022 were included in the study. These patients were categorized into two groups: those with preseptal cellulitis (group 1) and those with orbital–intracranial complications (group 2). Results The median age of the patients was 10.8 years, and 61.1% were males. Maxillary sinusitis (n = 40.74%) was the most common type of sinus involvement. Half of the patients exhibited preseptal cellulitis. The median age of our patients with intracranial complications was 13.7 years, while the median age of patients with orbital complications was 8 years. The predominant orbital–intracranial complication was meningitis, which accounted for 41% of the cases. All patients with a subdural abscess (n = 6) presented with frontal sinusitis, while all cases of cavernous sinus thrombosis (n = 3) involved the sphenoidal sinus. Surgical intervention was undertaken in 37% of cases. Streptococcus pneumoniae was the most frequently isolated microorganism. The median duration of hospital stay was 14 days, with a total median treatment duration of 21 days. There were no fatalities, although neurological sequelae were observed in 7.4% of patients (n = 4). Conclusion Preseptal cellulitis and meningitis remain the most common complications of sinusitis in children. Adolescents with sinusitis should be monitored closely for intracranial complications. The prevalence of S. pneumoniae as the most frequently detected pathogen underscores the importance of vaccination. [ABSTRACT FROM AUTHOR]

Purpose: To assess the radiological features and clinical outcomes of odontogenic orbital cellulitis. Method: Multi-centre retrospective study of odontogenic orbital cellulitis. Primary outcomes assessed were causal organism(s), clinical signs, radiological findings, management and visual outcomes. Results: Four patients with odontogenic orbital cellulitis were identified for inclusion. There was an equal proportion of men and women with a mean age of 43 years (range 25–56 years). All patients presented with an orbital compartment syndrome, with visual acuity of counting fingers (n = 1, 25%), hand movements (n = 1, 25%) and no perception of light (n = 2, 50%). The organisms implicated were Streptococcus milleri (n = 3, 75%) and Streptococcus constellatus (n = 1, 25%). MRI findings showed a subperiosteal abscess was present in all cases, which was characterised radiologically as a T1-hyperintense, T2 minimally hyperintense collection with restricted diffusion and a low apparent diffusion coefficient signal. Final visual acuity ranged from 6/6 to no light perception. One patient required an orbital exenteration due to extensive necrosis with sepsis and systemic deterioration. Conclusions: Odontogenic orbital cellulitis carries a serious risk of vision loss with a propensity to present with an orbital compartment syndrome secondary to Streptococcus species. Outcomes were highly variable, with two cases progressing to blindness of which one required an orbital exenteration. [ABSTRACT FROM AUTHOR]

Orbital abscesses are caused by infection within or near the orbit and show obvious signs of pain, proptosis and raised inflammatory markers. Diagnosis is based on clinical features and radiological imaging, and requires early antibiotics and often surgical drainage to save vision. Sub-Tenon's injections of triamcinolone acetonide (TA) have caused localized infections in previous reports, which have responded to therapeutic interventions. Here we report a case where a delayed presentation of an orbital abscess secondary to sub-Tenon's TA for persistent post-operative cystoid macular oedema, without obvious signs of infection, rapidly progressed to cause orbital compartment syndrome. Despite treatment, the patient lost complete vision in the affected eye. This case discusses the rare and unusual cause of abscess formation and a diagnostic dilemma. [ABSTRACT FROM AUTHOR]

Orbital abscesses are primarily seen in children as complication of ethmoid bacterial sinusitis. We report a case of invasive aspergillosis causing orbital abscess in an immunocompetent child which resolved with surgery followed by antifungal therapy. This case highlights need for histopathological, and microbiological examination, including fungal culture in such cases. [ABSTRACT FROM AUTHOR]

To report a case series of seven patients with late presentation of orbital/subperiosteal abscess following oral treatment of orbital cellulitis. A retrospective case series of all patients presented with orbital abscess following oral treatment of orbital cellulitis from two tertiary-care eye centres in Riyadh, Saudi Arabia, was conducted. Demographic profiles, risk factors, initial clinical presentation, management regimens, and final outcome were analysed. Patients presented mainly with proptosis and limitation of extraocular motility without external ophthalmic inflammatory signs. Most patients needed surgical evacuation despite the appropriate initiation of intravenous antibiotics following presentation to our hospitals. Treating orbital cellulitis with oral antibiotics may lead to delayed presentation of orbital abscess without external ophthalmic inflammatory signs. [ABSTRACT FROM AUTHOR]

Bichectomy is the partial removal of the Bichat's fat pad for the aim of smoothing the facial contour. The complications of bichectomy include soft tissue infections, hematoma, facial paralysis (especially buccal branch paralysis), stenon canal injuries and related complications such as sialocele and sialoadenitis, however these are not common complications in clinical practice. Here we report a case of a 29-year-old white female with a right sided orbital abscess following bichectomy. Right sided orbital abscess and orbital cellulitis was managed with endoscopic decompression and drainage. The patient healed completely with no sequela. The frequency of major complications leading to moridity after bichectomy is rare in the literature. This is the first reported intraorbital complication of bichectomy. [ABSTRACT FROM AUTHOR]

We present a unique case of acute on chronic left frontal sinusitis with an orbital abscess in the left orbit complicated by granulomatosis with polyangiitis and a defect to the structure of the orbit, among the 87 year old patient's other health-related conditions. Urgent transfer to tertiary care, and diagnostic, surgical, and multidisciplinary management were necessary to achieve a favorable clinical outcome: the eye was left undamaged and no infection spread to the brain. This report also sets out to review the literature. [ABSTRACT FROM AUTHOR]

To study the clinical, microbiological profile and management outcomes of orbital abscess at a tertiary care center in South India. In a retrospective interventional case series, we reviewed all patients diagnosed with orbital cellulitis from 2000–2020. The data analyzed included demographic profile, clinical and radiological features, microbiological profile, and management outcome. A total of 921 cases of orbital and periorbital infections were reviewed. Seventy-two cases were diagnosed as orbital cellulitis. Thirty-four cases (47.22%) had radiological evidence of orbital abscess. The median age was 20.63 years. Three patients (8.82%) were neonates. A male preponderance was noted (23, 67.65%). Sinusitis (10, 29.41%) and diabetes (5, 14.7%), were the most common predisposing factors. Optic neuropathy was seen in 15 (44.11%) patients, cavernous sinus thrombosis in two patients (5.88%), and septicemia in one patient (2.94%) Multiple orbital abscesses were noted in 7 (20.59%) cases. All patients underwent surgical drainage. Methicillin-sensitive Staphylococcus aureus was the most common organism isolated in 14 patients (41.18%). Vision improvement or stabilization was seen in all except 3 (8.82%) Orbital abscess is a potential sight-threatening orbital infection. The infective process can spread and ascend up to involve cavernous sinus thereby becoming life-threatening. A timely diagnosis and intervention can halt the disease process and help restore vision in many cases. [ABSTRACT FROM AUTHOR]

Periorbital infections lead to severe condition of the orbital abscess, and eventually to sight loss, and even death. Current study aims in reviewing the literature regarding orbital abscess in adult patients and presenting 2 original cases. A surgical intervention to drain the abscess and a revision of the orbital was required. A review of literature is also reported focusing on aetiology and treatment options dealing with an orbital abscess. [ABSTRACT FROM AUTHOR]

A 28-year-old male presented with gradually progressive swelling of the right lower eyelid along with a prominence of the eye for 6 months. He had received oral steroids and intraorbital triamcinolone acetonide injection in the inferior quadrant for active thyroid eye disease. External examination revealed right eye proptosis and swelling along the inferior orbital region. Magnetic resonance imaging showed an ill-defined soft tissue lesion in the inferior extraconal space and a bulky right inferior rectus. Histopathology of the biopsied material revealed inflammation with septate fungal filaments, identified as Aspergillus flavus on culture. He responded well to oral voriconazole despite a recurrence during the course of treatment. Intraorbital steroids are given for idiopathic and thyroid-associated orbital inflammation. This is a report of a rare complication of fungal orbital abscess following intraorbital corticosteroid injection in an immunocompetent young patient. [ABSTRACT FROM AUTHOR]

Orbital abscesses are most commonly associated with co-existing active paranasal sinus infection. Herein, the authors present the case of an orbital abscess in the setting of costal tubercular osteomyelitis and an anterior chest wall abscess in the absence of any paranasal sinus pathology in an immunocompetent patient. Costal tuberculosis is a very rare form of extrapulmonary skeletal tuberculosis and is challenging to diagnose. Initial presentation as an orbital abscess remote from the site of the primary pathology is of extremely rare occurrence. In this instance, the diagnosis of tuberculous osteomyelitis was suspected primarily on the basis of clinicoradiological features. The patient was treated with, and responded well to, standard first-line anti-tubercular therapy (ATT) for extrapulmonary tuberculosis. [ABSTRACT FROM AUTHOR]

Purpose: The role of adjuvant systemic corticosteroids in the management of periorbital cellulitis and subperiosteal/orbital abscesses secondary to sinonasal infections is not well understood. Our objective was to systematically review the current evidence on the efficacy and side effects of systemic steroids when used in the management of periorbital cellulitis. Methodology: A systematic review of literature was conducted in accordance with PRISMA guidance. A systematic search of MEDLINE, Embase and Cochrane databases, MetaRegister and ISI conference proceedings was conducted. The outcomes of interest were duration of inpatient stay, requirement for surgical intervention, adverse effects and recurrent/residual symptoms. Results: Four studies were identified involving 118 patients. Of these, 78 underwent treatment with systemic corticosteroids and 40 were controls. Meta-analysis demonstrated that the mean duration of inpatient stay was significantly shorter in the steroid group (WMD − 2.90 days; 95% CI − 3.07, − 2.73; p < 0.00001). There were no significant differences in requirement for surgical intervention (RR 0.93; 95% CI 0.50, 1.75; p = 0.83). Side effects were reported in 6/78 patients (7.7%), with 5 patients showing signs of hyperactivity and 1 patient with insomnia. These were mild except in one case, which required early cessation of corticosteroids. There was one case of recurrence of symptoms in each cohort (steroid vs. non-steroid) following discharge. Conclusions: The evidence suggests that systemic corticosteroids may offer some benefit in the management of periorbital cellulitis secondary to sinonasal infections. However, there is significant heterogeneity and risk of bias. A well-designed randomised controlled trial may provide a better insight into the efficacy of systemic steroids for this condition. [ABSTRACT FROM AUTHOR]

Pyomyositis is a rare condition which occurs most often in large skeletal muscles. Pyomyositis of extraocular muscles is a very rare entity. The authors describe a case of 2 sites of pyomyositis of extraocular muscles. A 20-year-old man presented with right periocular pain, redness, and proptosis for 1 week.Computed tomography showed well-circumscribed masses with enhancing rims in the medial and inferior rectus muscles. The patient underwent orbital drainage surgery and received an intravenous antibiotic. Haemoculture and pus culture could not identify an organism. Systemic steroid was administered after the infection was controlled, in regard to scar prevention. [ABSTRACT FROM AUTHOR]

A 44‐year‐old male Japanese was admitted for further post‐remission treatments for acute myeloid leukemia. He developed a right orbital abscess. An isolate of Lomentospora prolificans was obtained from the lesion, and orbital biopsy also revealed the presence of Aspergillus fumigatus. This fatal case involved a concurrent dual fungal infection. [ABSTRACT FROM AUTHOR]

Aim: To identify the predictors of poor outcome and need for surgical management in paediatric patients with periorbital cellulitis. To assess the adherence to local guidelines in the management of periorbital cellulitis.Methods: Retrospective descriptive analysis of clinical, laboratory and radiological characteristics of 175 paediatric periorbital cellulitis presentations at a UK teaching hospital over a 10-year period. Regression investigated correlations for continuous and categorical variables.Results: A total of 175 paediatric presentations were diagnosed as periorbital infections over the 10-year period. Of these, 139 had pre-septal cellulitis, 27 had a subperiosteal abscess, 6 had an orbital cellulitis, 1 had an orbital abscess, 1 a cavernous sinus thrombosis and 1 an extradural abscess. Median age at presentation was 5 years (range: 1 month-17 years). In total, 169 (97%) cases received systemic antimicrobial treatment. Cross-sectional imaging occurred in 30% of cases and 18% required surgical intervention. Increasing C-reactive protein was associated with greater risk of post-septal disease and requiring surgery. The best predictors of post-septal disease in the multivariate analysis (R2 = 0.49, P = ≤0.001) were ophthalmoplegia (P = 0.009), proptosis (P = 0.016) and pain on eye movement (P = 0.046). Proptosis was the single most significant predictor of surgical management (R2 = 0.53, P = <0.001).Conclusion: Multidisciplinary involvement and early medical management can improve outcomes for most patients. Those who deteriorate despite medical management should be considered for prompt imaging and surgical management to avoid serious life-threatening or sight-threatening complications. [ABSTRACT FROM AUTHOR]

Background: Subtenon injection of triamcinolone acetonide (STTA) has been widely adopted in the clinical setting of ophthalmology and its infectious complications are rare. However, orbital abscess following STTA has been reported in seven cases. Furthermore, although eye infections due to Exophiala species are uncommon, there have been 19 cases to date. E. jeanselmei, E. phaeomuriformis, E. werneckii, and E. dermatitidis have been reported to cause human eye infections; however, to the best of our knowledge, orbital abscess caused by E. dermatitidis has not yet been reported. We describe the first documented case of fungal orbital abscess caused by E. dermatitidis following STTA. We also review the related literature of orbital abscess following STTA, as well as eye infections caused by the four Exophiala species.Case Presentation: The patient was a 69-year-old Japanese woman with diabetic mellitus. She had a macular oedema in her right eye, which occurred secondary to branch retinal vein occlusion. An orbital abscess caused by E. dermatitidis occurred 4 months after the second STTA for the macular oedema, which was successfully treated by a surgical debridement and systemic administration of voriconazole.Conclusions: Our findings in the patient and from our literature survey caution ophthalmologists to the fact that STTA can cause fungal orbital infections, especially in diabetic patients. Furthermore, surgical treatment is one of the most important risk factors. [ABSTRACT FROM AUTHOR]

Background: Complications of acute sinusitis affecting multiple sites are very uncommon, and generally develop for a delayed diagnosis of the primary infection, with possible severe and life-threatening evolution. Patients can have variable presentations according to the site and extent of the infection. Multiple forms generally include the coexistence of orbital manifestations and intracranial infections. We here present a case with unusual multiple sites locations (i.e.: intraorbital intraconic abscess, sigmoid sinus thrombosis, preclival abscess, multiple splanchnocranium osteomyelitic processes). Case presentation: A 13-year-old male presented at our hospital with right progressive orbital oedema with eyesight worsening and signs of meningitis. Computed tomography and magnetic resonance (MRI) demonstrated right intraorbital intraconic abscess, left sphenoidal sinusitis, transverse and sigmoid sinus thrombosis. Ophthalmologic evaluation documented a right optic nerve sufferance. Endoscopic and superior right trans-palpebral surgical decompression was performed, and the abscess was drained. Microbiological analysis revealed the presence of multi-sensitive Streptococcus Intermedius. Subsequent prolonged antibiotic and anti-thrombotic treatments were started. In the following two-weeks the sinusal and ophthalmologic clinical conditions improved, whereas the patients complained of mild to moderate cervical pain and suffered from intermittent pyrexia. Control MRI documented clival abscess extending up to preclival soft tissues posterior to the nasopharynx, associated with mandible osteomyelitis, occipital condyles and anterior part of the temporal bone hyper intensity. Endoscopic trans-nasal surgical approach to the clival compartment with neurosurgery navigation-guided achieved preclival abscess drainage. Complete clinical and radiological recovery was achieved after 45 days of medical treatment. Conclusions: Multiple sites complicated rhinosinusitis is uncommon, and its management is challenging. A proper history and thorough clinical examination along with a radiological evaluation are key factors in the final diagnosis of patients with complicated multiple sites acute rhinosinusitis. A quick multidisciplinary approach is always necessary to avoid unwanted life-threatening complications. [ABSTRACT FROM AUTHOR]

Background: Intracranial and orbital abscesses in combination together are rare complications of sinusitis. They can be life-threatening and can result in multiple sequelae. Case presentation: A 9-year-old female presented with left periorbital swelling, gaze restriction and headache. Following scans, she underwent emergency endoscopic sinus surgery, evacuation of the intraorbital empyema and stereotactic minicraniectomy with the evacuation of the extradural empyema as a joint case. The patient recovered well and was discharged to complete intravenous antibiotics for 6 weeks. Conclusion: In the pediatric population intracranial complications of acute sinusitis can have more devastating consequences. Therefore, prompt recognition and management are essential within a multidisciplinary team setting. We also highlight the rarity of concomitant multi-site abscess formation and the need to be vigilant for same. [ABSTRACT FROM AUTHOR]

The aim of the study is to determine epidemiological profile of cases admitted with suspicion of pre or post septal cellulitis and to define and evaluate the various factors associated with the aetiology, presentation, diagnosis and management of orbital and preseptal cellulitis via a one year study of ten cases presenting to a tertiary care hospital in western Rajasthan, India. All patients presenting to our department or being transferred from other departments to us with the diagnosis of pre/post septal cellulitis from the March of 2017 to February 2018 were considered for this case series. Data compilation of these patients was done which included age, sex, chief complain, duration of illness, associated co-morbidities, time of presentation, management plan undertaken and associated radiological findings. All these aspects were then evaluated. Our study included 10 cases. Of these 8 were less than 14 years and 2 were over 50 years. Both the adults were female and were positive for Diabetes Mellitus type two. 80% of these patients presented between the duration of November to February with maximum (40%) in the month of December. In 7 of these 10 patients, the cellulitis was associated with underlying sinusitis. Six patients were admitted directly from ENT OPD while other 4 were being managed in other ward before being transferred to us. All patients were managed conservatively except 1 who required surgical intervention. Pre/post septal cellulitis is a dangerous condition in which prompt intervention needs to be undertaken as it can be difficult to predict what course it will follow. Radiological evaluation should be done in all cases as most cases are associated with an underlying sinus infection. Also, it is more common in paediatric age group and the patient may initially be referred to an ophthalmologist or a paediatrician in which case it becomes very important that a good working interdepartmental collaboration be present so that correct management plan can be followed. [ABSTRACT FROM AUTHOR]

Orbital compartment syndrome (OCS) is described in humans as an acute rise in intraorbital pressure following a severe and rapidly evolving orbital affection. It includes orbital oedema, haemorrhage or infection causing a marked reduction in local blood perfusion, and severely affecting the orbital neurovascular structures. If not promptly recognised and treated, it results in irreversible blindness. It is one of the rare ophthalmic surgical emergencies, requiring lateral canthotomy and cantholysis. This case report describes two canine cases of complex orbital, periorbital and facial abscesses resulting in OCS and permanent unilateral blindness diagnosed by ultrasonography, computed tomography and electroretinography. [ABSTRACT FROM AUTHOR]

Orbital cellulitis (OC) is an inflammatory process that involves the tissues located posterior to the orbital septum within the bony orbit, but the term generally is used to describe infectious inflammation. It manifests with erythema and edema of the eyelids, vision loss, fever, headache, proptosis, chemosis, and diplopia. OC usually originates from sinus infection, infection of the eyelids or face, and even hematogenous spread from distant locations. OC is an uncommon condition that can affect all age groups but is more frequent in the pediatric population. Morbidity and mortality associated with the condition have declined with advances in diagnostic and therapeutic options; however, OC can still lead to serious sight- and life-threatening complications in the modern antibiotics era. Therefore, prompt diagnosis and treatment remain crucial. Antibiotic coverage, computed tomography imaging, and surgical intervention when needed have benefitted patients and changed the disease prognosis. We review the worldwide characteristics of OC, predisposing factors, current evaluation strategies, and management of the disease. [ABSTRACT FROM AUTHOR]

A 22-year-old Quarter Horse gelding with a history of dental (107) extraction 2 weeks previously was presented with facial cellulitis and an orbital abscess. The abscess was drained surgically dorsally and ventrally to the zygomatic arch and the horse was treated with parenteral antimicrobial and anti-inflammatory drugs. The affected eye was protected with a temporary tarsorrhaphy and treated via a subpalpebral catheter. Six months after presentation, the horse was in excellent general condition and returned to previous level of exercise but showed blindness on the affected side. Pallor of the optic disc and severe attenuation of the retinal vessels, suggestive of optic disc atrophy, were present. [ABSTRACT FROM AUTHOR]

Objective Pediatric periorbital cellulitis represents a common disease complicating a nasal infection. Methods A ten–year retrospective review of fifty-seven children admitted to our institution with the diagnosis of periorbital cellulitis as a complication of sinus infections was carried out. Results The age varied from one month to eleven years (mean 3.9 years). Thirty-five were males (62%), while twenty-two were females (38%). Nine out of fifty-seven (15.8%) presented exophthalmos associated with eyelid erythema and edema, while the rest suffered mainly from eyelid erythema and edema. Twenty-two patients complaining of exophthalmos or not responding to medical therapy within 48 h were assessed with a computed tomography scan (38.6%). A subperiosteal orbital abscess was detected in nine cases and these patients underwent surgical drainage (15,8%). Recurrence of orbital infection occurred in three cases (5.3%). Conclusions Medical management is the main treatment for both preseptal and postseptal orbital cellulitis. Nevertheless, there is no universally accepted guideline for the treatment of subperiosteal abscesses and each case should be treated accordingly. Urgent surgical drainage should be considered in cases not responding to adequate medical management, or those cases presenting visual deterioration. [ABSTRACT FROM AUTHOR]

Today, in spite of improved diagnostic tools and appropriate antibiotic usage, life-threatening complications of sinusitis such as orbital abscess and subdural empyema can still be observed. These complications may cause serious, disabling sequelae even after treatment. Presently described is case of a 12-year-old girl with frontal-ethmoidal sinusitis, orbital abscess and subdural empyema. Prompt diagnosis and treatment resulted in an uncomplicated outcome. In patients with subdural empyema, early diagnosis is possible with cranial magnetic resonance imaging (MRI) and surgery is not necessarily required for clinical improvement. Otolaryngologists should pay attention to additional symptoms such as confusion or loss of consciousness in patients with orbital abscess in order to diagnose a secondary complication such as subdural empyema promptly. [ABSTRACT FROM AUTHOR]

Dacryoadenitis, a condition defined as inflammation of the lacrimal gland, has many etiologies; rarely is it associated with a lacrimal gland abscess. In this article, a 7-year-old African American boy was diagnosed with a lacrimal gland abscess secondary to oxacillin-resistant Staphylococcus aureus (ORSA). The incidence of conditions arising from ORSA, a term used interchangeably with methicillin-resistant S aureus (MRSA), is reportedly on the rise in our population over the past decade. Recognition of atypical pathogens, initiation of timely appropriate-spectrum pharmaceuticals, and conservative follow-up are imperative in treating and preventing potentially vision-threatening sequelae of dacryoadenitis. [ABSTRACT FROM AUTHOR]

A 59-year-old patient developed acute proptosis, peri-orbital swelling and restriction of ocular movements 2 days after attempted scleral buckle removal. Initial clinical and orbital MRI findings were suggestive for orbital cellulitis and orbital abscess. Empiric intravenous antibiotics were not effective. Proton magnetic resonance spectroscopy (MRS) revealed a distinctive composition and helped rule out suppurative and neoplastic processes. The patient recovered soon after removing clear liquefied and tiny particles of the hydrogel buckle by an effective peristaltic technique. [ABSTRACT FROM AUTHOR]

A 58-year-old woman presented to the emergency department with left ptosis and complete ophthalmoplegia. Imaging demonstrated a left orbital abscess. Her past medical history included cavitatory lung disease and “aseptic” meningitis 2 months previously. An anaerobic organism and commensal of the oral flora,Peptostreptococcussp., was cultured from the orbital abscess. The patient was found to have a carious upper molar with chronic buccal abscess, which was extracted. This case presents an uncommon pathogen arising from an odontogenic infection as the etiology for orbital abscess, cavitatory lung disease, and meningitis in one patient. [ABSTRACT FROM PUBLISHER]

A seventeen-year-old girl was admitted to our clinic with complaint of rubor, swelling, and pain on the left upper eyelid. Her medical history revealed that she had received high-dose oral steroid treatment for one week for the diagnosis of acute angioedema in another clinic. On ophthalmologic examination, her left upper eyelid had edema, swelling, and hyperemia. Additionally, she had restriction in up-gaze in the left eye. Her best-corrected visual acuity was 0.7. The patient's computerized tomography revealed ethmoidal, maxillary and frontal sinusitis, as well as subperiostal orbital abscess, and frontal epidural abscess. Intravenous antibiotic treatment has been arranged. Due to persistence of the clinical signs, surgical drainage of the abscesses has been performed. Following, she has been discharged from the hospital on oral antibiotic treatment. Postoperatively, at the first-month visit, the left eye's up-gaze restriction was recovered, and visual acuity was improved to 1.0. If a patient presents with eyelid swelling, differential diagnosis should be performed carefully before making the decision to start steroid treatment. Sinusitis, which is seen frequently in clinical practice, should be kept in mind due to its potential to cause orbital abscess, epidural abscess, and intracranial complications. [ABSTRACT FROM AUTHOR]

Orbital abscess is life-threatening and rare in children. Reported herein is a term male neonate who had methicillin-resistant Staphylococcus aureus orbital abscess, and a literature review of this disease. A total of 16 neonates diagnosed with neonatal orbital abscess are reported in the literature. There is a mild male predilection and two neonates were delivered prematurely. Leukocytosis, fever, ethmoiditis and associated upper respiratory tract infection were found in approximately half of them. Eight neonates had sepsis and 14 patients underwent surgical intervention. One patient died. Staphylococcus aureus was identified in 14 out of 17 patients. Neonatal orbital abscess is rarely encountered but may be fatal. Although streptococci are prevalent in childhood orbital infection, S. aureus was predominant in neonatal orbital abscess in the present series. Appropriate antimicrobial therapy against S. aureus is essential in treating neonatal orbital abscess. This case suggests that a higher initial dose of vancomycin may be an effective and safe strategy for severe S. aureus infection in neonates. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of the present study was to compare the external (EA), transnasal endoscopic (TEA), and combined (CA) external and transnasal approaches to drain orbital subperiosteal abscesses complicating pediatric ethmoiditis. Methods: This retrospective study included 38 children consecutively operated in our center for an orbital subperiosteal abscess complicating an acute ethmoiditis. The distribution of surgical approaches used for our patients was the following: 12 TEA (32%), 21 EA (55%) and 5 CA (13%). All data were retrieved from patients’ clinical charts. Results: No surgical complication was observed in the present study regardless of the approach. The percentage of surgical failures requiring additional drainage was almost twice as high after TEA (failure rate: 25%) than after EA (failure rate 14.3%), but this difference was not significant. Parameters which significantly influenced the risk of failure of TEA were the length and width of the abscess. The duration of postoperative hospitalization was significantly lower in the TEA group (3.1 days) than in the EA one (5.4 days). There were no failures in the CA group. Conclusions: Failures of surgical drainage of orbital subperiosteal abscess complicating pediatric ethmoiditis are not rare and did not differ between external and transnasal endoscopic approaches in our study. The transnasal route is associated with a shorter postoperative duration of postoperative hospitalization. CA seems to be a viable surgical option combining the advantages of both endoscopic and external approaches. [Copyright &y& Elsevier]

The article discusses a study on the efficacy of transorbital neuroendoscopic surgery (TONES) for the management of sinogenic complications involving the frontal sinus, orbit and anterior cranial fossa in a prospective series of 13 patients presented with these symptoms. Results demonstrated the safety and efficacy of TONES in the management of sinogenic complications and the procedure's use as a primary surgical modality or in multiportal combination with endonasal approaches.

Orbital cellulitis is an uncommon condition previously associated with severe complications. If untreated, orbital cellulitis can be potentially sight and life threatening. It can affect both adults and children but has a greater tendency to occur in the pediatric age group. The infection most commonly originates from sinuses, eyelids or face, retained foreign bodies, or distant soources by hematogenous spread. It is characterized by eyelid edema, erythema, chemosis, proptosis, blurred vision, fever, headache, and double vision. A history of upper respiratory tract infection prior to the onset is very common especially in children. In the era prior to antibiotics, vision loss from orbital cellulitis was a dreaded complication. Currently, imaging studies for detection of orbital abcess, the use of antibiotics and early drainage have mitigated visual morbidity significantly. The purpose of this review is to describe current investigative strategies and management options in the treatment of orbital cellulitis, establish their effectiveness and possible complications due to late intervention. [ABSTRACT FROM AUTHOR]

Introduction: Complications associated to group-A streptococcal pharyingitis include non-suppurative complications such as acute rheumatic fever and glomerulonephritis and suppurative complications such as peritonsillar or retropharyngeal abscess, sinusitis, mastoiditis, otitis media, meningitis, brain abscess, or thrombosis of the intracranial venous sinuses. Case presentation: We described a case of a 15-year-old patient with a history of acute pharyngodinia early followed by improvise fever and a progressive formation of a diffuse orbital edema, corneal hyperaemia, diplopia and severe decrease of visual acuity. The patient was surgically treated with functional endoscopic sinus surgery (FESS) after the response of a maxillofacial computed tomography scans that showed a pansinusitis complicated by a left orbital cellulites. Numerous colonies of Streptococcus pyogenes were found in the samples of pus and an antibiotic therapy with meropenem was initiated on the basis of the sensitivity test to antibiotics. The patient was finally discharged with diagnosis of left orbital cellulites with periorbital abscess, endophtalmitis and acute pansinusitis as a consequence of streptococcal pharyngitis. Conclusion: The case highlights the possible unusual complication of a group-A streptococcal pharyingitis in a immunocompetent child and the needing of a prompt surgical and medical approach toward the maxillofacial complications associated to the infection. [ABSTRACT FROM AUTHOR]

Pediatric preseptal and orbital cellulitis are infectious disorders that result in periorbital inflammation. Preseptal cellulitis is often associated with breaches in the skin barrier whereas orbital cellulitis is commonly associated with paranasal sinusitis. Orbital cellulitis may be associated with subperiosteal abscess. It is important to distinguish between preseptal from orbital cellulitis. Clinical examination and diagnostic imaging are useful in determining appropriate management. Patients are usually treated with broad spectrum antibiotics and surgery when indicated. [ABSTRACT FROM AUTHOR]

Purpose: Acute dacryocystitis commonly presents as preseptal cellulitis as lacrimal sac lies anterior to the orbital septum and hence infection localizes in the preseptal space. The purpose of this study is to describe presentation and management of cases of acute dacryocystitis presenting as orbital cellilitis and abscess secondary to acute dacryocystitis. Method: This retrospective, non-comparative, interventional case series included 6 patients presenting with orbital cellulitis and abscess secondary to acute dacryocystitis. All patients underwent drainage of abscess under general anesthesia. External dcaryocystorhinostomy was advised as the definitive treatment for all pateints. Result: Abscess was localized in the extraconal space in 4 patients and in the intraconal space in 2 patients. Patients with intraconal abscess had visual loss on presentation while vision could be preserved in patients with abscess in extraconal space. Both patients with intraconal abscess had history of acute dacryocystitis. Conclusion: Acute dacryocystitis is an ophthalmic emergency that can cause orbital cellulitis with abscess formation, and even vision loss, if left untreated. [ABSTRACT FROM AUTHOR]

Objective To determine bacterial populations, in vitro antimicrobial susceptibility patterns, and sources of microorganisms for dogs and cats with orbital abscess. Animals studied In total, 34 dogs and 7 cats with orbital abscess participated in the study. Procedure Medical records of dogs and cats with a clinical diagnosis of orbital abscess, confirmed by cytologic or histopathologic evaluation of orbital specimens, were reviewed from the years 1990 to 2007. Animal signalment, presumptive source of microorganisms and mechanism of orbital introduction, bacterial isolates, and aerobic bacterial in vitro antimicrobial susceptibility test results were recorded. Percentages of susceptible aerobic bacterial isolates were compared among antimicrobials. Results Twenty dogs and five cats had positive culture results. The most frequent bacterial genera isolated from dogs were Staphylococcus, Escherichia, Bacteroides, Clostridium and Pasteurella. The most frequent bacterial genera isolated from cats were Pasteurella and Bacteroides. Aerobic bacterial isolates from dogs had the highest percentage of susceptibility to amikacin, ceftiofur, gentamicin, imipenem, ticarcillin and trimethoprim–sulfamethoxazole. Aerobic bacterial isolates from dogs had the lowest percentage of susceptibility to ampicillin, clindamycin, erythromycin and penicillin. Antimicrobial resistance was uncommon among feline aerobic bacterial isolates. The most commonly identified routes of orbital bacteria introduction were extension from adjacent anatomical structures, penetrating exogenous trauma, and foreign bodies. Conclusions Mixed aerobic and anaerobic bacterial infections of the orbit occur commonly in dogs and cats. On the basis of aerobic and anaerobic bacterial isolates and in vitro susceptibility testing of aerobic bacterial isolates, cephalosporins, extended-spectrum penicillins, potentiated-penicillins and carbapenems are recommended for initial antimicrobial therapy of orbital abscess in dogs and cats. [ABSTRACT FROM AUTHOR]

Summary: Objective: To determine the pattern of pre-hospitalization antibiotic use in children developing a subperiosteal orbital abscess (SPA) as a complication of acute sinusitis. Study design and setting: Ten-year retrospective chart review in a tertiary pediatric center of children under the age of 18 years requiring operative drainage of a SPA as a complication of acute sinusitis. Results: There were 39 children (M 25; F 14). Ten children (26%) received antibiotic therapy prior to admission, for a median duration of 1.6 days. On presentation, 72% had rhinorrhea and/or fever, for average durations of 3.9 and 2.5 days, respectively. Streptococcal species sensitive to penicillin were grown from 51% of SPA cultures. Conclusion: Although few children in this series received antibiotics prior to their presentation with a SPA, prodromal sinusitis symptoms were of too short a duration to warrant institution of antibiotic therapy based on the American Academy of Pediatrics guidelines for acute sinusitis. Significance: SPA may not be a preventable complication of acute sinusitis in children. [Copyright &y& Elsevier]

Summary: Objective: To evaluate the presentations and outcomes of pediatric subperiosteal orbital abscesses (SPOA) secondary to acute sinusitis. Study design: Case series Setting: Tertiary children''s hospital. Patients: Forty-three admissions diagnosed with SPOA by clinical presentation and contrast enhanced computed tomography (CECT) were retrospectively reviewed. Main outcome measures: Clinical presentations, CECT dimensions, treatment, outcomes, and microbiology. Results: Eighteen/43 (42%) patients resolved their infection with medical management only, including five children older than nine. Twenty-five/43 (58%) children underwent surgical drainage. Purulence was identified in 22 of 25 surgical patients, and the most common organism was Streptococcus milleri (7 patients). Compared to 22 patients with drained purulence, the 18 patients with abscesses managed medically had significant differences for: chemosis in 2/18 (11.1%) versus 14/22 (63.6%, p =0.001), proptosis in 10/18 (55.6%) versus 20/22 (90.9%, p =0.025), elevated intraocular pressure (IOP) in 0/18 (0%) versus 11/22 (50%, p <0.001), severe restriction of extraocular movements in 1/18 (5.6%) versus 12/22 (54.5%, p =0.002), and length of stay (4.3 versus 5.8 days, p =0.038). The dimensions of medial SPOA managed medically were significantly smaller on CECT compared to surgically drained purulent SPOA: width (0.25 versus 1.46cm, p <0.001), height (0.73 versus 1.35cm, p =0.002), and length (1.1 versus 1.86cm, p =0.004). Persistent morbidities occurred in no patients managed medically and in 2/25 (8%) managed surgically. Conclusions: Children with small medial SPOA without significant ocular signs may be managed medically with favorable outcomes. Proposed criteria for medical management of medial SPOA include: (1) normal vision, pupil, and retina; (2) no ophthalmoplegia; (3) IOP<20mmHg; (4) proptosis of 5mm or less; and (5) abscess width of 4mm or less. In contrast to prior series, older children with SPOA were managed successfully with medical therapy. [Copyright &y& Elsevier]

Orbital cellulitis due to presumed gas-producing organisms has been associated with poor visual prognosis. We report successful visual recovery in a 14-year-old boy with orbital cellulitis and gas in the orbit on CT scan. The patient was treated with intravenous antibiotics and prompt orbital decompression. Pus from the sinus aspirate and orbital drain grew H. influenzae and Gram-negative bacilli. Repeat orbital surgery with drainage of residual abscess was performed and the patient made a complete recovery. [ABSTRACT FROM AUTHOR]

Orbital abscess and superior orbital fissure syndrome (SOFS) are rare manifestations of herpes zoster ophthalmicus. Herein, we report a case of orbital abscess along with SOFS in a 2.5-year-old-male child secondary to herpes zoster infection. He presented with a 5-day history of proptosis and ptosis of the right eye that had been preceded by vesicular eruptions on the right forehead and scalp. Computed tomography scan of the head and orbit showed orbital abscess and right cavernous sinus thrombosis. A diagnosis of orbital abscess with SOFS secondary to herpes infection was made. The condition subsequently improved following antiviral therapy, intravenous vancomycin and amikacin, and oral corticosteroids. [ABSTRACT FROM AUTHOR]

Background: Bacterial orbital cellulitis is an uncommon condition previously associated with severe complications. The purpose of this paper is to describe current investigations and treatment in orbital cellulitis, establish their effectiveness and to describe the incidence of complications and surgical intervention. Methods: A chart review of all patients admitted to the Royal Victorian Eye and Ear Hospital and the Royal Children’s Hospital, Melbourne with a diagnosis of orbital cellulitis for the period July 1993 to July 1997. Results: A total of 52 patients fulfilling the diagnostic criteria for orbital cellulitis were identified. Paranasal sinus disease was the commonest predisposing cause, especially in the paediatric age group. Diagnosis was made clinically with radiological confirmation in all cases. Microbiological investigation and results varied. The commonest species isolated were Staphylococci and Streptococci. Three cases of mixed anaerobes and one of Clostridium were seen. Cultures from abscess cavities and infected sinuses gave the highest positive yield (50–100%). Blood cultures were taken in 26% of adults and in 56% of children; none was positive. Treatment was either by intravenous broad-spectrum antibiotics alone or with surgery to drain orbital abscesses, usually in conjunction with sinus surgery. No patient suffered permanent visual impairment other than one case of enucleation for endophthalmitis that had caused orbital cellulitis. There was one case of permanent ocular motility impairment, and one of meningitis. Conclusions: Despite its past history of severe morbidity and even mortality, adequately treated orbital cellulitis rarely has significant morbidity today. Paranasal sinus disease remains the commonest cause. Culture of infected paranasal sinuses or pus from abscesses is most likely to yield significantly positive results in this study. Blood cultures were not helpful. [ABSTRACT FROM AUTHOR]

This review of the literature on orbital infections focusses on bacterial infections of the preseptal space, subperiosteal abscesses, orbital phlegmon and orbital abscesses. The need for a timely diagnosis of and multidisciplinary approach to treatment of these infections, which may lead to life-threatening complications, is emphasized. [ABSTRACT FROM AUTHOR]

A 63-year-old female with Graves' disease and chronic sinusitis presented with acute left orbital pain and proptosis five years after bilateral orbital decompression and sinus surgery. Imaging revealed bilateral frontal sinus opacification, frontoethmoidal mucoceles and left subperiosteal mass. Presence of an optic neuropathy drove emergent management with intravenous antibiotics and orbitotomy with exploration. Intra-operatively, a left orbital abscess and left frontal sinus purulence were drained. The patient regained her vision with relief of proptosis and pain. [ABSTRACT FROM AUTHOR]

There remains variation in management of orbital complications of acute bacterial rhinosinusitis (ABRS); specifically, those subperiosteal abscesses that present without immediate surgical indication. Recent systematic reviews on management and proposed treatment algorithms are helpful but do not consider the financial implications for healthcare systems and patients. A retrospective chart review of pediatric patients from a tertiary care children's hospital between 2002 and 2020 was performed, identifying patients via ICD coding corresponding to acute bacterial sinusitis and orbital involvement classified as Chandler 3 confirmed by contrasted computed tomography (CT). Two groups of patients were identified: intravenous (IV) antibiotics alone and IV antibiotics plus surgery. Billing records of total hospital charges and physician fees were recorded for financial analysis. Demographic, length of stay, and charges were analyzed. 58 patients with ABRS and Chandler 3 orbital involvement were confirmed by CT imaging. Twenty-nine (50%) were treated with IV antibiotics alone, and twenty-nine (50%) underwent surgery in addition to IV antibiotics. There were no significant differences in patient demographics. The average total hospital charges for the medically managed group were $9262 ± 4831 compared to $30,830 ± 11,397 for the surgical group (p < 0.0001). In the medically managed group, the average hospital fees were $7305 ± 4048 and the average physician fees were $1543 ± 799. In the surgical group, the average hospital and physician fees were also significantly higher at $23,071 ± 7305 (p < 0.0001) and $7763 ± 3335 (p < 0.0001), respectively. Patients who were treated medically and had a longer than average LOS still had significantly fewer charges than those treated with antibiotics plus surgery and a shorter than average length of stay [$15,311 and $27,723, respectively (p = 0.02)]. Pediatric ABRS with orbital involvement requires prompt attention and management. Controversy persists over subperiosteal abscess management that present without overt surgical indications. Surgical intervention is expensive. Our subgroup analysis demonstrates the magnitude of this cost difference. Specifically, longer inpatient stays with IV antibiotics alone appear to be significantly cheaper than shorter ones that include surgery. Not all Chandler 3 patients are candidates for non-surgical management; however, clinicians are encouraged to keep these data in mind for those patients where further medical management is safe and may yield less expensive clinical resolution. [ABSTRACT FROM AUTHOR]

Orbital abscess formation in neonates is rare, with only 12 cases reported in the literature. We present a case of orbital cellulitis with orbital abscesses following repair of congenital choanal atresia in a 2-week-old neonate. This is the first reported case of an orbital abscess following a sinus procedure in a neonate. [ABSTRACT FROM AUTHOR]

A 22-year-old female with multiple developmental abnormalities stemming from cardiofaciocutaneous syndrome presented with a recurrent orbital abscess 2 years after orbitotomy with drainage of an abscess of presumed hematogenous-origin. During careful intraoperative examination the abscess was seen to directly extend from the lacrimal sac. Cultures were taken and grew Morganella morganii, a Gram negative rod uncommon in ocular and periocular infections. To the author’s knowledge, this microorganism has been reported in only one previous case of orbital abscess and underscores the need for organism identification and antibiotic sensitivity analysis in cases of orbital abscess, particularly those with extension from dacryocystitis. [ABSTRACT FROM AUTHOR]

We present a patient who developed an orbital abscess secondary to a retained organic (wooden) foreign body after a fall. Clinically, he had a right sub brow fistula exuding purulent discharge, four millimetres of proptosis, limitation of ocular motility in all directions of gaze, but no signs of optic neuropathy. Preoperative computed tomography and magnetic resonance imaging of the orbits was performed to localise the abscess and to facilitate surgical planning. He underwent exploration, drainage of the abscess and removal of the wooden foreign body with good postoperative recovery. Cultures isolated Ganulicatella Adiacens, a nutritionally variant streptococcus. This is an unusual causative organism and to our knowledge, this is the first reported case of a posttraumatic orbital abscess associated with Granulicatella Adiacens. Clinical suspicion, isolation of the organism and appropriate microbial treatment requires a multidisciplinary approach, with input from the ophthalmologist, microbiologist and infectious disease team. This will ensure a good outcome in patient management. [ABSTRACT FROM AUTHOR]

Exposure is one of the most frequent complications of porous orbital implants, while infection is rarely observed. Atypical mycobacteria are ubiquitous germs of mostly variable pathogenicity. A patient with recurrent orbital implant exposure is described, in whom a final diagnosis of Mycobacterium abscessus infection was made on culture of the orbital implant remnant at its removal. In orbital implant exposure, infection with unexpected organisms should be considered and in these cases only the complete removal of the implant may allow the socket to settle. [ABSTRACT FROM AUTHOR]

Orbital abscess is a serious infection which demands immediate and aggresive management. A case of orbital abscess associated with central retinal vein occlusion in a seven year old girl is reported. The diagnosis was established by computerised tomographic scanning and confirmed by bacteriological examination. [ABSTRACT FROM AUTHOR]

Abstract Acute dacryocystitis usually presents as a preseptal infection, but can uncommonly be associated with orbital cellulitis. Orbital abscess formation is, however, very rare. The case is presented of a 60-year-old woman with an extraconal abscess secondary to acute dacryocystitis. The clinical, radiological and intraoperative findings are discussed. [ABSTRACT FROM AUTHOR]