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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]

Introduction: The diagnosis of ocular pathology by point-of-care ultrasound (POCUS) has been well established for entities such as retinal detachment, vitreous hemorrhage, posterior vitreous detachment, and lens dislocation.1 However, the use of ultrasound to detect other conditions such as orbital abscess and endophthalmitis in the emergency setting is rarely reported. Case Report: We present a case in which POCUS was used to confirm the suspected diagnosis of endophthalmitis and orbital abscess. This case report will review the ultrasonographic findings of orbital abscess and endophthalmitis, as well as briefly discuss the literature for the use of ultrasound for these applications. Conclusion: Point-of-care ultrasound can be used to rapidly diagnose infectious pathology of the eye and orbit, which could potentially decrease time to diagnosis and time to consultation of these visionthreatening pathologies. [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]

Background: Orbital, intracranial, and osseous extra-sinus complications can arise from bacterial or fungal sinusitis. Odontogenic sinusitis (ODS) can cause extra-sinus complications, but its prevalence remains poorly characterized. Objective: To determine the frequency of ODS as a cause of operative extra-sinus infectious complications and describe clinical features of all complicated sinusitis cases. Methods: A multi-institutional retrospective review was performed on all operative sinusitis-related extra-sinus complications from 2011 to 2020. ODS was diagnosed by sinus computed tomography (CT) and dental evaluations when available. Demographics, complication types, sinusitis etiologies, and various clinical features were analyzed. Results: Forty-five patients were included (mean age 55.5 years, 56% male). Of the extra-sinus complications, 40% were orbital only, 22% intracranial only, 13% osseous only, and 25% involved combined complications. The 2 most common causes of extra-sinus complications were ODS (40%) and mucopyocele (27%). When invasive fungal etiologies were excluded, and only unilateral maxillary opacification on CT was considered, nearly 60% of extra-sinus complications were due to ODS. Unilateral maxillary sinus opacification on CT was present in 100% of complicated ODS compared to 44% of nonodontogenic cases, and oral anaerobes were only identified in ODS cases. No complicated ODS patients underwent dental interventions during hospitalization. Conclusion: ODS was the most common cause of operative extra-sinus infectious complications. Clinicians should consider ODS high on the differential diagnosis of all patients presenting with complicated sinusitis, especially when sinusitis is unilateral and invasive fungal infection is not suspected. [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]

Copyright of MN Opthalmology / MN Oftalmoloji is the property of Medical Network and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Introduction: Limited data is available on paediatric orbital cellulitis in Asia. We aimed to describe demographic data, clinical presentation, predisposing factors, identified microorganisms, choice of antibiotics and management in children with orbital cellulitis treated in a tertiary care centre in Malaysia.Methods: A retrospective review was performed on children with orbital cellulitis aged below 18 years who were admitted to Hospital Universiti Sains Malaysia, Kelantan, Malaysia, between January 2013 and December 2017.Results: A total of 14 paediatric patients fulfilling the diagnostic criteria for orbital cellulitis were included. Their mean age was 6.5 ± 1.2 years. Boys were more likely to have orbital cellulitis than girls (71.4% vs. 28.6%). Involvement of both eyes was observed in 14.3% of the patients. Sinusitis (28.6%) and upper respiratory tract infection (21.4%) were the most common predisposing causes. Staphylococcus aureus (28.6%) was the leading pathogen. Longer duration of hospitalisation was observed in those infected with methicillin-resistant Staphylococcus aureus and Burkholderia pseudomallei. 10 (71.4%) patients were treated with a combination of two or three antibiotics. In this series, 42.9% had surgical interventions.Conclusion: Young boys were found to be more commonly affected by orbital cellulitis than young girls. Staphylococcus aureus was the most common isolated microorganism. Methicillin-resistant Staphylococcus aureus and Burkholderia pseudomallei caused severe infection. Sinusitis and upper respiratory tract infection were the most common predisposing factors. A majority of the children improved with medical treatment alone. Our findings are in slight disagreement with other published reports on paediatric orbital cellulitis, especially from the Asian region. [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]

Background: Orbital infection related to mandibular third molar infection is extremely rare. Most of cases reported in literature are related to maxillary molar teeth. Odontogenic infections are not common causes of orbital abscess but it should always be put in consideration when dealing with orbital cellulitis and abscess.Case presentation: This is a case of orbital abscess involving the left eye as consequence of lower left third molar infection in otherwise healthy 35-year-old black male patient. CT scan confirmed the unusual pathway of this space infection from the lower third molar and excluded any intracranial involvement. The abscess was drained immediately by intraoral incisions and the tooth was extracted. There was a dramatic improvement in a very short time with normal eye movement.Conclusion: This case demonstrates one of the serious consequences of odontogenic infection which may lead to cavernous sinus thrombosis and blindness if not treated promptly. [ABSTRACT FROM AUTHOR]

Background: Orbital abscess formation is one of the uncommon complications that occur following facial trauma. We report a rare presentation of orbital abscess in a young adult with post closed facial fracture. Materials and Methods: a case report. Result: A 19-year old man who sustained head injury and facial bones fractures without any external adnexal wounds from a road traffic accident. He developed left periorbital haematoma and decrease vision after 3 days of trauma. He was suspected to have left optic neuropathy and empirically treated with corticosteroids. However, his left vision deteriorated and developed progressive proptosis within 3 days. Serial CT scan showed new formation of left subperiosteal and intraconal abscess. Endoscopic orbital decompression and drainage of the abscess was performed. Post operatively, his vision and the proptosis improved. Orbital abscess post closed facial fracture is an unusual complication. Conclusion: High index of suspicion is necessary to diagnose this unusual presentation. Prompt treatment is essential to save the vision. [ABSTRACT FROM AUTHOR]

Efforts aimed at minimizing the spread of COVID-19 and "flattening the curve" may be affecting clinical care delivery for non-COVID-19 cases that include otolaryngologic and orbital conditions. We are witnessing changes in the manner that patients present, as well as modifications in clinical management strategies. An improved understanding of these phenomena and the contributing factors is essential for otolaryngologists to provide sound clinical care during this unprecedented pandemic. [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]

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]

Odontogenic orbital abscess is a rare but well-documented complication of sinusitis and infections spreading from dental apical lesion. We report a case of orbital abscess with periorbital cellulitis, in a 35-year-old man with positive recent dental history of a periapical dental infection arising from the second upper left premolar spread into maxillary sinus. The patient has shown facial edema, ocular pain, ophthalmoplegia, proptosis, and initial visual symptoms. A surgical intervention to drain the abscess and a revision of the dental lesion and maxillary sinus were required. A review of literature is also reported focusing on etiology and treatment options dealing with odontogenic orbital abscess and cellulitis. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Superior pediatric orbital subperiosteal abscesses (SPAs) are less common than medial ones, and clinical features specific to patients with superior SPAs have not been well defined. Clinical characteristics between patients with superior and medial SPAs are compared to determine whether superior location is a risk factor for surgical intervention.Study Design: Retrospective cohort study.Methods: The target population consisted of patients diagnosed with an SPA and seen by the pediatric otolaryngology service at a tertiary children's hospital between January 2010 and October 2014. Imaging characteristics including proptosis, hypoglobus, intraorbital air, and abscess volume as well as treatment interventions were reviewed.Results: Forty patients between 5 and 17 years of age treated for an orbital SPA were identified. Thirteen patients were identified as having superior SPAs; 27 had medial SPAs. The average ages in the two groups were 10.92 and 9.26 years, respectively. The odds ratio for surgical treatment per each increasing year of age was 1.5 (P = .004). The proportion of patients requiring surgery was significantly different between the groups (12/13 superior vs. 13/27 medial, P = .01). The predominant organism group cultured in surgical patients was Streptococcus anginosus (8/24, 29.17%). Superior SPA patients had significantly more proptosis, hypoglobus, and abscess volume on computed tomography scan.Conclusions: Patients with superior SPAs may present with more advanced disease, leading to a higher rate of characteristics such as proptosis, hypoglobus, and intraorbital air, factors that would predispose to surgical drainage. We found that abscess volume was the most predictive of surgery.Level Of Evidence: 4 Laryngoscope, 127:735-740, 2017. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Kartal Training & Research Hospital / Kartal Egitim ve Arastirma Hastanesi Tip Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Copyright of Turkish Journal of Ophthalmology / Turk Oftalmoloji Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Background: Orbital infection is an uncommon devastating infection and is usually a complication of paranasal sinus infection. Without appropriate treatment, orbital infection may lead to serious complications, even death. Prompt treatment is mandatory to avoid visual loss or intracranial complications. The literature shows that initially, intravenous antibiotics should be administered, and after 48 h, if no improvement appears, the affected orbit and the sinuses must be surgically drained. The authors describe two cases of orbital cellulitis with a brief literature review. Case report: The authors describe two cases of orbital abscess caused by paranasal sinus infection. In case 1, the patient presented a decreased visual acuity associated with ophthalmoplegia of the right eye. In case 2, the patient presented a decreased visual acuity. Thus, administration of intravenous antibiotic combined with surgical drainage was performed. After surgical procedure, eye movements were normalized in case 1, and in both patients, the visual acuity returned to normal parameters. Discussion: The authors recommend early surgical drainage with parenteral antibiotic administration and careful postoperative observations by monitoring the signs and symptoms of the orbital complaint. [ABSTRACT FROM AUTHOR]

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.

Background: Pott's puffy tumor (PPT) is a frontal subperiosteal abscess associated with underlying frontal bone osteomyelitis. It represents a well-known source of sinogenic intracranial infection, but the orbital complications related to this entity are rarely reported. The goal of this study was to characterize the orbital involvement in PPT. Methods: We performed a systematic review through a Medline search (1950-2010). The authors reviewed all cases of PPT, selecting those explicitly describing orbital complications associated with PPT. Results: We screened 139 articles, of which 93 reported cases of PPT. Of these, 35 articles described a total of 42 cases presenting simultaneous orbital complications. Eyelid and/or periorbital edema was the most common finding in patients with orbital involvement, and preseptal cellulitis is by far the most prevalent orbital complication in PPT. Postseptal involvement (orbital cellulitis, subperiosteal abscess of the orbit, and orbital abscess) is much rarer. Although treatment of the classic PPT is surgical, only a minority of patients with orbital infection required orbital drainage. Most reported patients made a full recovery, without permanent sequelae. Conclusion: Orbital infections are possible in patients with PPT. In contrast to surgical treatment of the frontal subperiosteal abscess, the orbital complications can be treated conservatively most of the time. Early diagnosis and aggressive therapy of the underling PPT are essential to avoid severe local or systemic complications. [ABSTRACT FROM AUTHOR]

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]

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]

A case of anaerobic orbital cellulitis secondary to intraorbital wood and an approach to management are presented. Retained foreign bodies should be suspected in all penetrating orbital injuries involving wood. Computed tomography (CT) should be performed to delineate the location and size of any foreign body and to determine damage to adjacent structures. Magnetic resonance imaging (MRI) is useful in certain circumstances. Orbital infection should be anticipated and broad-spectrum antibiotic cover (including anaerobes) provided. Surgical intervention should be undertaken to remove any retained foreign bodies to prevent vision-threatening complications. [ABSTRACT FROM AUTHOR]

A study was made of 112 children with preseptal cellulitis, orbital cellulitis, subperiosteal abscess, and orbital abscess. These were consecutive admissions to the Royal Alexandra Hospital for Children, Sydney, during the period June 1976 to August 1985. The average age was 3 years 6 months. The clinical and radiological signs for each group were defined. Of the 112 children, 43.8% (with an average age of 3 years 3 months) had a clinical history of an upper respiratory tract infection. Trauma was a factor in 13.4% of patients. Haemophilus influenzae was recovered from blood culture in two patients and from conjunctival culture in seven patients. The average age of this group was 3 years 7 months. Plain radiographs taken of 53 patients revealed evidence of paranasal sinus disease in 29 (54.7%). Computerized tomography was performed in 14 patients. Of seven patients requiring surgical drainage of orbital or subperiosteal abscess (average age 7 years 2 months), five had clinical upper respiratory tract infection. [ABSTRACT FROM AUTHOR]

A series of 65 patients suffering from acute inflammatory disease of the orbit was studied by CT. Ethmoiditis was the cause in the vast majority; trauma and dental extraction played a lesser role in causation. Orbital cellulitis was diagnosed in 17 and subperiosteal abscess in the remaining 48. It was not possible to differentiate 33 pus-containing abscesses from the six with inflammatory masses (phlegmons). The satisfactory response to aggressive medical treatment in those patients with inflammatory masses that were not drained justifies a more conservative approach; surgical drainage being reserved for those with a deterioration in proptosis, ocular movements or vision. Six abscesses arose de novo, of which some were in the orbital fat rather than the subperiosteal space. [ABSTRACT FROM AUTHOR]