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Orbital abscesses in children are not uncommon. Unless managed in a timely fashion, they can potentially lead to vision-threatening as well as life-threatening complications. The objective of this study is to report the clinical and microbiological profile and management outcomes in infants presenting with orbital abscesses.A retrospective review of electronic medical records of children younger than 1 year with a diagnosis of an orbital abscess was done. The data was collected from a time period of 12 years (2007-2019). The data collected included mode of presentation, radiological, microbiological and histopathological features, and the final outcome.A total of nine patients met the inclusion criteria. The mean age at presentation was 19 weeks. Three patients had upper respiratory tract infection, one had a congenital nasolacrimal duct obstruction, two had sinusitis, and one patient had neonatal sepsis. All patients underwent imaging following which abscess drainage was performed. Methicillin-sensitive Staphylococcus aureus was the most common organism, which was isolated in five patients, Methicillin-resistant S. aureus was isolated in three, while one patient had Entomophthorales fungal infection. The median follow-up period was 10 months (range 5 days to 89 months). There was no recurrence in the cohort. At least one patient had visual impairment at the last follow up.Orbital abscesses in infants are rare. Imaging and prompt drainage of the abscess supplemented by appropriate antimicrobial regimen leads to a successful outcome.

We report a rare case of a patient who developed an orbital abscess several years after successful orbital medial wall fracture repair. A 37-year-old female patient who underwent orbital fracture repair with a titanium Medpor® orbital implant two years prior visited the clinic for pain, conjunctival injection, discharge, and lid swelling of the right eye. Orbital CT revealed severe orbital cellulitis and sinusitis. After administering antibiotics, the sinusitis was successfully resolved. However, the orbital inflammation around the implant did not improve, forming an orbital abscess. Abscess drainage and implant removal were performed. The removed implant was infected at the center, exhibiting a yellowish abscess-like discoloration. The patient improved rapidly and recovered without complications. In rare cases, orbital cellulitis and orbital abscesses develop even after a considerable period of time after orbital fracture repair using a non-absorbable porous orbital implant. In such cases, delayed orbital implant infection should be suspected as the cause, and an imaging study should be performed. If the patient does not respond to antibiotic treatment, it may be necessary to remove the infected implant with immediate drainage.

Approccio chirurgico multidisciplinare nel management delle complicanze orbitarie delle patologie infiammatorie naso-sinusali.L’infezione orbitaria come complicanza di una patologia infiammatoria nasosinusale può portare a gravi sequele, incluse cecità e morte, se non trattata. La comunicazione tempestiva e diretta tra l’otorinolaringoiatra, il neuroradiologo, l’oculista, il neurochirurgo e il chirurgo maxillo-facciale è fondamentale per garantire un trattamento di successo. Le celluliti pre-settali si risolvono con terapia antibiotica ad ampio spettro. Anche la cellulite orbitaria è responsiva al trattamento farmacologico nella maggior parte dei casi. Il management dell’ascesso subperiosteo (SPA) è invece controverso. Un approccio chirurgico aggressivo è sempre consigliato in caso di trombosi del seno cavernoso. Il timing e il tipo di approccio (endoscopico o esterno) sono oggetto di dibattito nella scelta chirurgica. Il chirurgo dovrebbe essere preparato a convertire un approccio endoscopico in uno esterno, se necessario. La decompressione di una o più pareti orbitarie può essere necessaria se la pressione rimane elevata. La chirurgia è immediata nei bambini con SPA o ascesso orbitario di grandi dimensioni o in pazienti immunocompromessi. Un eventuale peggioramento della funzione oftalmologica deve essere attentamente considerato come un fattore deponente per un trattamento chirurgico.Orbital infection complicating sinonasal inflammatory disorders may lead to serious sequelae, including blindness and death, if untreated. Communication between the otorhinolaryngologist, neuroradiologist, ophtalmologist, neurosurgeon and maxillo-facial surgeon is critical and time-sensitive for a successful treatment. The large majority of pre-septal cellulitis cases resolves after broad-spectrum antibiotic therapy. Also orbital cellulitis has been found responsive to pharmacological approach in most cases. The management of the subperiosteal abscess (SPA) is more controversial. An aggressive surgical approach is always recommended also in case of cavernous sinus thrombosis. In cases of surgical indication, debate is still open on the timing and the approach (endoscopic or external). The surgeon should be prepared to convert an endoscopic approach to an external one if needed and this should be included in the informed consent. Decompression of one or more orbital walls may be necessary if orbital pressure remains elevated. Immediate surgery is indicated in children with large SPA or orbital abscesses (OA), or in immune-compromised patients. Moreover, any worsening in the ophthalmological function must be carefully considered as a landmark in candidacy to surgery.

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

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., When multifocal fungal infections are found in a highly immunocompromised patient, physicians should be prepared for possible double or more fungal pathogens rather than single one, especially in the case that the effect of antifungal agents is insufficient on the lesions.

Defining current inpatient management of cervicofacial infections is key to identifying strategies to optimise care. Steroid use is beneficial in peritonsillar and orbital abscess, but there are few studies of steroid use in odontogenic cervicofacial infections. Our previous research identified widespread variation in practice, necessitating a national audit to define current practice. A multicentre, trainee-led snapshot audit was carried out across 25 hospitals in the UK. Information recorded included demographic features, presentation, surgical and medical management, and steroid administration. One thousand two admissions were recorded. Fifty-five percent were male, with mean age 37.3 years (range 0–94 years). Steroids were administered to 357 patients (36%), 159 of whom received steroids on admission, and 254 peri-operatively. Patients who were prescribed steroids had significantly higher white cell count (12.4 vs 11.5), CRP (79.5 vs 57) and heart rate (94 vs 88) on admission. Justifications given for administration included swelling (74), dysphagia (21), and airway compromise (7). Three patients (0.8%) reported steroid-related side effects. This study uses the largest recorded cohort of cervicofacial infections to define current inpatient steroid administration. Our results suggest that steroids are targeted towards the most compromised 1/3 of patients. The incidence of steroid-related side effects was low. Defining the characteristics of patients currently receiving steroids will aid in determining whether steroid administration is an effective adjunct in treating odontogenic cervicofacial infection.

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.

Eye globe rupture with consequent enucleation is an extremely rare complication of orbital infection spreading from maxillary sinusitis related to dental implant surgery. We report a case of orbital abscess leading to rupture of the globe of the eye in a 60-year-old woman with acute unilateral maxillary sinusitis after dental implant surgery on the left maxillary alveolar bone. The patient had uncontrolled diabetes. Despite surgical intervention, infection of the maxillary sinuses spread to the ocular area, causing disastrous results. To our knowledge, this entity has not been reported previously.

Purpose To describe the demographics, clinical presentation, treatment, and outcomes of a rare cohort with simultaneous orbital and intracranial abscesses. Methods A historical cohort study of 17 patients with simultaneous orbital and intracranial abscesses between 2010 and 2018 was performed. The demographics, location of abscesses, treatment, and outcomes of these patients were analyzed. Results The mean age was 26.9 years (range 5-83 years). Fourteen patients (82%) were male. In this cohort, the most common orbital abscess location was the superior orbit, involved in 14 patients (82%). The most common site of intracranial abscess was the frontal lobe, involved in 16 patients (94%). Concurrent sinus disease was present in 16 patients (94%). Surgical evacuation was the standard of treatment, with 94% of patients undergoing at least one surgical procedure. Streptococcus species were the most common, isolated from 6 sinus cultures (43%), 3 orbitotomy cultures (21%), and 4 craniectomy cultures (36%). Staphylococcus species were also common. Most patients (94%) had stable or improved mental status and visual function at the conclusion of their treatment. Conclusions Simultaneous orbital and intracranial abscesses are rare. Local invasion from the orbit into the intracranial space may occur from direct spread, thus superior orbital abscesses pose the greatest risk for intracranial spread. Additional factors such as infection with Streptococcus and Staphylococcus species as well as male sex appear to be risk factors for intracranial spread. For those who develop intracranial abscesses, young age and absence of seizures or altered mental status at presentation may be associated with favorable outcomes.

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.

Orbital cellulitis is the most common acute complication of ethmoidal sinusitis. A study of 4 cases, presented to ENT OPD with orbital swelling since 3-5 days and ipsilateral nasal discharge. History, CT findings, vitals with ophthalmic evaluation were noted. All the patients received systemic antibiotics with topical decongestant nasal drops and topical eye ointment and drops. Complications of rhinosinusitis result from progression of acute or chronic infection beyond the paranasal sinuses. In children it is more likely that there will be no prior history of sinusitis, the complication often being the first presentation. Early administration of broad- spectrum IV antibiotics can reduce the risk of further life- threatening complications and even abate the need for surgery., {"references":["John C Watkinson, Scott brown's Otolaryngology head and neck surgery, Carl Philpott: Rhinosinusitis definations, classification and diagnosis vol 1 p1025","John C Watkinson, Scott brown's Otolaryngology head and neck surgery, Stephan Ball and Sean Carrie: Complications of Rhinosinusitis vol 1 p1113.","Dankbaar JW, van Bemmel AJ, Pameijer FA. Imaging findings of the orbital and intracranial complications of acute bacterial rhinosinusitis. (2015) Insights into imaging. 6 (5): 509-18.","Brook I . Microbiology and antimicrobial treatment of orbital and intracranial compications of sinusitis in children and their management. Int J Pediatr otolaryngol 2009: 73(9) 1183-6","Ferguson MP, McNab AA (1999) Current treatment and outcome in orbital cellulitis. Aust N Z J Ophthalmol 27:375–379","Erickson B, Lee W (2015) Orbital cellulitis as a complication of sinusitis. J Nurse Pract 7(1):38–44","Elshafei AMK, Sayed MF, Abdallah RMA (2017) Clinical profile and outcomes of management of orbital cellulitis in Upper Egypt. J Ophthalmic Inflamm Infect 7:8 13. Buchanan M, Muen W, Heinz P (20","McMullan B, Andresen D, Blyth C et al. Antibiotic duration and timing of the switch from intravenous to oral route for bacterial infections in children: systematic review and guidelines. Lancet Infectious Diseases, The, 2016-08-01, Volume 16, Issue 8, Pages e139-e152.","Nwaorgu OGB, Awobem FJ, Onakoya PA, Wabem AAA. Orbital cellulitis complicating sinusitis: a 15 year review. Niger J surg Res. 2004;6(1–2):14–16.","Chaudhry IA, Shamsi FA, Elzaridi E, Al-Rashid W, Al-Amri A, Al-Anezi F, et al. Outcome of treated orbital cellulitis in a tertiary eye care centre in the middle East. Ophthalmology. 2007;114(2):345–354. doi: 10.1016/j.ophtha.2006.07.059.","Todman MS, Enzer YR. Medical management versus surgical intervention of pediatric orbital cellulitis: the importance of subperiosteal abscess volume as a new criterion. Ophthalmic Plast Reconstr Surg. 2011;27(4):255-259.","I D Singh, Lt Col V G, S Gupta, Anubhav. Acute Orbital Cellulitis: A Case Series. Glob J Oto 2017; 3(3): 555614","Chandler JR, Langenbrunner DJ, Stevens ER. The pathogenesis of orbital complications in acute sinusitis. Laryngoscope. 1970;80(9):1414-1428.","WILLIAMSON-NOBLE, F A.: Disease of the orbit and Its Contents Secondary To Pathological Conditions Of The Nose And Paranasal Sinuses. Ann. Roy. Col. Surg. Eng, 15:46-64, July, 1954.","BATSON, O. V: Relationship of the Eye to Paranasal Sinuses. Arch. Ophthal, 16:322-328, Jan, 1936.","Pereira FJ, Velasco e Cruz AAV, Anselmo-Lima WT, Elias Júnior J. Computed tomographic patterns of orbital cellulitis due to sinusitis. Arq Bras Oftalmol 2006;69:513-8.","Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg 2015;152:1-39.","John C Watkinson, Scott brown's Otolaryngology head and neck surgery ,Carl Philpott: Rhinosinusitis definations classification and diagnosis vol 1 p1025","Abou-Hamad W, Matar N, Elias M, Nasr M, Sarkis-Karam D, Hokayem N, et al. Bacterial flora in normal adult maxillary sinuses. American journal of rhinology & allergy. 2009;23(3):261–3. doi:10.2500/ajra.2009.23.3317.","DeMuri G, Wald ER. Acute bacterial sinusitis in children. Pediatrics in review / American Academy of Pediatrics. 2013;34(10):429–37. quiz 37. doi:10.1542/pir.34-10-429.","Wilson MT, Hamilos DL. The nasal and sinus microbiome in health and disease. Current allergy and asthma reports. 2014;14(12):485."]}

Objective: This article reports a case of a chronic maxillary sinusitis complicated by right orbital abscess with ruptured globe following tooth extraction in a 70-year-old female diabetic patient 4 weeks after forceps extraction of the upper right 1st premolar. Case Description: Patient gave a history that prior to the tooth extraction, there was a carious cavity on the tooth, pain on mastication with background nasal congestion and post nasal drip of over one year duration. 4 weeks following extraction, there was marked right buccal and periorbital swelling. Examination by the ophthalmologist revealed rupture of the right globe with copious pus discharge from the lower eyelid of the right eye. Examination by the dental team and the Head and Neck Surgeon revealed the presence of oroantral communication with pus discharge from the oroantral fistula and the retropharyngeal area. Fasting Blood Sugar on presentation was 278mg/dl. Patient was referred to the physician for optimization of her blood sugar level. Evisceration of the right eye was carried out along with incision and drainage of the right eyelid and buccal space. Intravenous ceftriaxone 1g daily, intravenous metronidazole 500mg 8 hourly, intramuscular genticin 80mg 8 hourly, eusol A&B dressing twice daily, paracetamol per oral 1g 8 hourly, menthol crystals steam inhalation twice daily, Diazepam 5mg nocte were prescribed for the patient. Inferior meatal antrostomy with antral washout was carried out by the Head and Neck Surgeon 2 weeks after. Following surgery, patient was placed on per oral Tavanic 500mg once daily, metronidazole 400mg 8 hourly, vitamin c 100mg 8hrly, guaifenesin/pseudoephedrine 25mg nocte, diclofenac potassium 50mg twice daily and menthol crystals steam inhalation twice daily. Review of the patient four weeks after surgery showed marked improvement in the clinical parameters of the patient, disappearance of swelling and cessation of pus from all points of previous discharge. Conclusion: Chronic maxillary sinusitis complicated by right orbital abscess with ruptured globe following tooth extraction may be considered a potential complication of forceps extraction of maxillary premolars and molars especially in a medically compromised patient. The authors hereby recommend (1) ensuring adequate medical and dental evaluation of patients before forceps extraction (2) all medically compromised patients must be optimized before forceps extraction (3) The need for multidisciplinary management of medically compromised patients with dental diseases Keywords: Orbital Abscess, Maxillary sinusitis, communication, globe rupture, Forceps extraction, Mellitus

Nocardia is a rare cause of endophthalmitis in immunocompetent individuals with poor visual outcomes. We, herein report a 15 month otherwise healthy child, who presented with hyphema, vitreous hemorrhage and secondary glaucoma following a vague history of trauma in the left eye 2 months before presentation. He presented a week later with features of panophthalmitis which were confirmed on B-scan and orbital CT scan. CT scan with contrast revealed the presence of multiple ring enhancing abscesses in the vitreous cavity and also in the intraconal space. Evisceration was done and smear and cultures revealed Nocardia. Rare presentation in a healthy pediatric patient and typical CT scan findings are discussed.

Highlights • Subperiosteal orbital abscess is a rare complication of a dental infection. • Antibiotics alone are ineffective and do not guarantee arrest of the infection spread. • The possible route of infection spread should be determined, and is illustrated in this report. • Postseptal infections require a more aggressive approach compared to preseptal infections. • In case of an orbital infection, intraoral examination and dental radiography may not be overlooked., Introduction Subperiosteal orbital abcess is a rarely reported complication of odontogenic infections and can be associated visual impairment and neurological symptoms. Because of fast infection spreading, delay in diagnosis and treatment can result in permanent damage. Presentation of case A 55-year old presented with a right-sided subperiosteal orbital abscess originating from a decayed first upper molar. The associated loss of vision improved only after a extraoral surgical drainage. Three years later, recurrent headaches, photobia and ptosis still persist. Discussion Our case demonstrates a rare but potentially hazardous complication of untreated dental infections. The effect of antibiotics is often overestimated, and lack of treatment may lead to serious sequelae, certainly when the orbital infection is located posterior to the orbital septum. When intraoral drainage is insufficient, the infection should be accessed extraorally. Conclusion Orbital infections require a thorough clinical evaluation, including the oral cavity as dental infections may be overlooked. Dental radiograpy plays a major role. Prompt and adequate treatment is crucial in preventing further spreading of odontogenic infections.

Introduction: Considering the little evidence regarding peri-orbital infections, this study was aimed to obtain information about the epidemiology, etiology, and management of orbital infections. Material and Methods: In this retrospective investigation, all patients with peri-orbital infection who were hospitalized in a tertiary ophthalmologic center in AL-Zahra hospital, Isfahan, Iran from 2008 up to 2018 were identified. Documented data and radiographic images were extracted. The data regarding epidemiology, etiology and disease course was analyzed. Results: Sixty nine patients (35 males, 34 females) with the age range between 3 months to 85 years were included. Preseptal cellulitis was recorded in 53 cases (76.8%) and orbital cellulitis was seen in 16 cases (23.2%), and the proportion of preseptal to orbital was 3.3 to 1. The mean duration of hospitalization in patients with preseptal cellulitis was 6.38 ±, 4.59 days and in patients with orbital cellulitis was 12.44 ±, 9.63 days. Most patients with preseptal cellulitis were treated by medication therapy (71.7%), while the orbital cellulitis were often treated by surgical procedures (56.2%). Sinusitis was the main cause of both preseptal and orbital cellulitis in all age groups, except infants under 1 year, which dacryocystitis was identified as primary factor. Conclusions: The prevalence of peri-orbital infection was higher in children. The prevalence ratio of preseptal to orbital cellulitis was 3.3:1. The main etiologic factor was sinusitis. There is no agreement for the treatment modalities of peri-orbital infections and the timing of surgical intervention. Continuous evaluation of treatment course, both clinically and radiographically is important. Reassessment is recommended when improvement is not seen after 6-7 days of treatment.

The orbital infections are known to be the most frequent primitive orbital pathology. Rhinosinusitis (RS) is the most common cause of orbital inflammation and infection, especially in the pediatric range. So far, the main orbital complication of RS is the preseptal cellulitis. The dissemination of the infection in the orbital retroseptal area may occur and is considered to be a serious complication requiring urgent diagnosis and treatment. It is usually seen as an orbital (OSPA) subperiosteal abscess adjacent to the infected sinus. The diagnosis of an OSPA is based on clinical evaluation as well as X-ray imaging. The CT scan is the preferred imaging modality for orbital abscess diagnosis. In most cases of OSPA, the surgery is often indicated and can be conducted by an external method, transnasal endoscopy or a combined method. In this article, we describe the technique of external drainage using an intravenous cannula (case report of 10 patients) as well as the results obtained.

Introduction: We report a rare case of pan sinusitis with orbital cellulitis in a 3-year-old male child. Orbital cellulitis is considered as an ocular emergency which needs urgent evaluation and proper quick action to save the patient vision or even life. It can affect both adults and children but has a greater tendency to occur in the pediatric age group. Methods: A 3-year-old male child presented to us with history of fever since 15 days. Later he developed swelling of left eye lid since 8 days. His visual acquity was fixating and following light. On anterior segment examination there was diffuse upperlid edema of left eye associated with mild erythema and matting of lashes. On MRI, it shows left sided pansinusitis with orbital cellulitis. Results: In view of left sided pansinusitis with orbital cellulitis, Functional Endoscopic Sinus Surgery with orbital decompression was done. Pus from the middle meatus was taken, sent for culture and sensitivity and the organism isolated was methicillin resistant Staphylococcus aureus (MRSA) positive growth and child was continued on antibiotics i.e., Teicoplanin and Metrogyl. Patient showed marked improvement in both ocular and general condition. Conclusion: Currently, imaging studies for detection of orbital abscess, 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. This case report will be of interest particularly to the ophthalmologists, the otorhinolaryngologists, and the paediatricians.

A 10-month-old girl presented with eyelid edema and erythema that did not improve with systemic antibiotics. Due to a lack of improvement, MRI was performed to avoid ionizing radiation from CT. An orbital abscess was recognized and drained. However, the abscess recurred 2 times. CT scan was performed and a tract in the sphenoid bone helped to diagnose a congenital dural sinus tract with dermoid. Definitive surgery was performed with neurosurgery to remove the entire tract including cutaneous connection. CT scan proved critical to diagnosis and should be considered in infants in select cases despite the concern for ionizing radiation in this vulnerable age group.

This study aims to identify predictive factors associated with surgical intervention and the visual outcome of orbital cellulitis and to evaluate the treatment outcomes. A retrospective study involving 66 patients (68 eyes; 64 unilateral and 2 bilateral) diagnosed with bacterial orbital cellulitis was conducted between November 2005 and May 2019. The mean (± standard deviation) age was 42.1 (± 25.8) years (range: 15 days–86 years). Sinusitis was the most frequent predisposing factor, occurring in 25 patients (37.9%), followed by skin infection in 10 patients (15.2%), and acute dacryocystitis in 9 patients (13.6%). Subperiosteal abscesses were found in 24 eyes and orbital abscesses in 19 eyes. Surgical drainage was performed in 31 eyes. Regarding the abscess volume for surgical drainage, a cut-off of 1514 mm3 showed 71% sensitivity and 80% specificity. There was significant improvement in visual acuity (VA) and decrease in proptosis after treatment (for both, P ≤ .001). Only pre-treatment VA ≤20/200 was a significant predictor for post-treatment VA of 20/50 or worse (adjusted odds ratio: 12.0, P = .003). The presence of a relative afferent pupillary defect was the main predictor of post-treatment VA of 20/200 or worse (adjusted odds ratio: 19.0, P = .003). The most common predisposing factor for orbital cellulitis in this study was sinusitis. VA and proptosis significantly improved after treatment. We found that the abscess volume was strongly predictive of surgical intervention. Pre-treatment poor VA and the presence of relative afferent pupillary defect can predict the worst visual outcome. Hence, early detection of optic nerve dysfunction and prompt treatment could improve the visual prognosis.

Central retinal artery occlusion (CRAO) is an ophthalmic emergency and has poor visual prognosis. It is commonly found in elderly people and very rare in child. We reported an 8-year-old girl who suffered from acute sinusitis, periorbital swelling, and the visual acuity of her right eye was only light perception. She was diagnosed with CRAO, SPOA (subperiosteal orbital abscess), and acute sinusitis. Emergency treatments including surgery, antibiotics, glucocorticoids, intraocular-pressure-lowering drugs, and vasodilators were taken immediately in order to save the eyesight. The visual acuity of the right eye returned to 20/400. Conclusions: Severe intraorbital complications of acute sinusitis can lead to CRAO. Timely drainage, strong antibiotics, and glucocorticoids are the most effective methods for the treatments.

Introduction: Primary tooth eruption occurs at approximately six months of age. Neonatal teeth, defined as teeth that erupt within 30 days after birth, are uncommon, estimated to occur in 1:1,000 to 1:30,000 live births. Orbital infections in neonates are exceedingly rare. The small number of cases reported in the literature attribute ethmoid sinusitis as the underlying etiology of most neonatal orbital infections. This report describes orbital cellulitis and subperiosteal orbital abscess resulting from an infected neonatal tooth. Case Description: A 25-day-old, former full term, male presented with one day of fever and right eye swelling. Exam …

A 35-year-old man was hit against his left eye by his child’s foot. Two days following trauma, the patient noticed diplopia in the upward and right gazes. On the first examination seven days after trauma, computed tomographic (CT) images revealed a small mass in the inferolateral orbit near the inferior orbital fissure. There was no radiological evidence of orbital fracture, paranasal sinusitis, or foreign body. Immediately after the first examination, the patient had a history of fever, retrobulbar pain, and nausea. These symptoms gradually worsened, and the patient visited the emergency department of our hospital at 13 days following trauma. CT images showed enlargement in the size of the mass. The diagnosis of the orbital abscess was made, and emergent drainage of the abscess was performed, followed by administration of intravenous antibiotics. On the fifth postoperative day, cultures of the abscess specimen showed growth of Fusobacterium nucleatum (4+), Parvimonas micra (4+), and Prevotella intermedia (4+). The patient’s condition improved significantly and at the 1.5-month follow-up, the patient did not have any symptoms related to the orbital abscess.

Highlights • COVID-19 can affect the presence of bacteria within certain anatomical regions. • Peptoniphilus indolicus is usually found in the vagina or gut biome, but it can be found in the sinonasal cavity in a COVID patient as well. • The sinonasal cavity can become avascular as a result of COVID infections. • Although rare, orbital abscesses can drain spontaneously or require enucleation., Background Peptoniphilus indolicus is not usually seen in the eye or paranasal sinuses but is a commensal of the human vagina and gut. However, with COVID-19, eye infections and other unusual complications are possible with such unsuspected bacteria. Case presentation The patient is a 76-year-old white male from a nursing home tested positive for COVID-19 and was sent from a nursing facility for left eye drainage and psychiatric evaluation. Upon presentation, the patient was not fully oriented and could not provide a history of the eye drainage. CT scan showed sinusitis with left orbital and periorbital abscess formation, cellulitis, and extensive osteomyelitis. He underwent endoscopic transnasal drainage and orbiotomy. Cultures returned positive for methicillin-resistant Stapholococcus aureus (MRSA), Streptococcus constellatus, and Peptoniphilus indolicus. He was maintained on several days of IV antibiotics and returned to the nursing home. He then presented 2 months later and required enucleation of his globe, due to the presence of multiple scleral perforations in the setting of orbital abscess, as well as removal of necrotic orbital bone. Conclusions Given the concomitant infection with COVID-19 and unusual presentation, the patient’s sinus cultures support the notion that COVID-19 can affect the presence of bacteria within certain anatomical regions. Specifically, Peptoniphilus indolicus is not normally found outside of the vagina or gut biome. Avascular, pale mucosa and bone of the nasal cavity was noted during surgery of this COVID-19 infected patient, which is in contrast to the friable and edematous tissue typically found in acutely infected sinuses. Our patient’s orbital abscess began to drain spontaneously through the skin, which is rare for orbital abscesses. Also uncommon with orbital abscesses is the need for enucleation, which in this case was deemed necessary given that the abscess had perforated the sclera in multiple locations.

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.

Odontogenic infections are common and very often spread to potential spaces of head and neck. The spread of such infection to adjacent maxillary sinuses or distant sites such as the orbits are a rare occurrence and may develop periorbital and orbital cellulitis. Unfortunately once orbital cellulitis and subsequently orbital abscess develops it can give rise to serious complications such as complete blindness or even more serious and life-threatening situations as cavernous sinus thrombosis, intracranial abscess or even death. Two cases are presented to demonstrate the differences between the two conditions and the necessary management in either case. This article provides an insight into the clinical behaviour of orbital infections of odontogenic origin with contemporary diagnostic and treatment modalities that will help in reducing morbidity and mortality associated with these conditions.

Introduction: Acute invasive rhino-orbital mucormycosis usually affects diabetic or neutropenic patients, and only exceptionally develops in immunocompetent adults and children. Methodology: A 12-years-old immunocompetent female, presented with complicated rhinosinusitis with a subperiosteal orbital abscess, without improvement after initial medical and surgical management, the patient also developed hyperglycemia of the hospitalized patient that represented a challenging and potentially lethal clinical scenario. Results: Diagnosed with an unsuspected rhino-orbital mucormycosis by direct microscopy and PCR, she survived after amphotericin B and surgical treatment. Conclusions: In cases with torpid clinical evolution, even in apparently immunocompetent patients, appropriate multidisciplinary workup must be performed to rule out opportunistic etiologies including mucormycosis to improve survival.

Neonatal orbital infections are quite rare, and are most often attributed to ethmoid sinusitis. This report describes a case of subperiosteal orbital abscess in a neonate secondary to an infected neonatal tooth. Although there have been two cases reported in the literature describing odontogenic infection resulting in orbital abscess in neonates, these cases were due to infected tooth buds rather than an infected neonatal tooth. We discuss workup and surgical management of this patient, including tooth extraction and intraoral approach to the orbit for abscess drainage.

Background The extent of surgery required in the management of pediatric non-medial subperiosteal orbital abscess (SPOA) due to medically refractory complicated acute sinusitis is unknown. Objectives The primary objective is to compare operative outcomes of children treated with combined endoscopic sinus surgery (ESS) and external orbital drainage (EOD) versus those treated with EOD alone. Methods Retrospective case series from a tertiary children’s hospital analyzing outcomes in children requiring surgical management for acute sinusitis complicated by non-medial SPOA between November 2007 and September 2019. Results Sixteen children with a mean age of 9.4 years (95% CI: 7.3–11.4) met inclusion. Eleven (68.8%) underwent combined EOD and ESS, while five (31.2%) underwent EOD alone. Groups were similar in age, symptom duration, white blood cell count, C-reactive protein level, intraocular pressure, Lund-Mackay score, and abscess volume. There was no significant difference in median length of stay between patients treated with a combined approach versus those treated by EOD alone. Cultures identified non-beta-hemolytic Streptococcus species in 56.3% of patients, with Streptococcus intermedius representing the most common organism in 37.5%. In one case, ESS identified a pathogen not acquired via concomitant EOD, which did influence management. No child required a subsequent surgical procedure and there were no operative complications. Conclusions The addition of ESS in the management of pediatric non-medial SPOA was not associated with a statistically different duration of hospitalization. Cultures from concomitant ESS rarely aided in diagnosis or antibiotic therapy. Further study should delineate the indications for ESS in these cases.

Peptoniphilus indolicus is not usually seen in the eye but is a commensal of the human vagina and gut. However, with COVID-19, eye infections and other unusual complications are possible with unsuspected bacteria. The patient presented here spontaneously drained this bacteria through the skin, an uncommon occurrence with orbital abscesses.

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.

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 mini-craniectomy 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.

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.

Introduction Orbital complications of rhinosinusitis in adults are scarcely discussed in the literature. We defined atypical orbital complications as those without typical orbital invasion and not classified by the Chandler classification. These complications present as visual loss of diplopia without soft tissue swelling, pain, or computed tomography images of an orbital abscess. Objectives The objective of this study was to review our experience with the management of atypical orbital complications of rhinosinusitis and to identify key factors in the characteristics of these patients. Methods A retrospective case series review was conducted from 2015 to 2019 in a tertiary referral center, which included all patients with rhinosinusitis and orbital complications. Results Five patients were identified with atypical complications in the orbital area. Two of the 5 patients exhibited vision loss without any other symptoms. Two patients showed diplopia with or without ptosis. One patient had a headache and ptosis. Complete recovery was noted in 4 of the 5 patients after endoscopic sinus surgery. Conclusion With future studies, new surgical criteria, including retinal destruction, location of the sinusitis, the onset of ophthalmological symptoms, and culture results may be added to the classical surgical criteria to manage orbital complications of paranasal sinus infection cases.

Penetrating orbital trauma in the pediatric population is rare. Even more unusual is a secondary orbital infection following penetrating trauma. Here we present a highly unusual case of fulminant facial cellulitis with an orbital abscess in an otherwise healthy 3-year-old boy following a penetrating injury to the orbit from a point of entry on the gingiva-buccal sulcus, sustained during a fall while carrying a wooden lollipop stick. Examination of the retina revealed a focal injury at the inferior pole of the globe. The organisms cultured from pus sampled from the abscess and from the discharging intraoral wound revealed the same oral commensals while the MRI revealed a track in continuity with the orbital collection.

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.Keywords: Dog, Globe tenting, Orbital abscess, Orbital compartment syndrome, Unilateral blindness

Introduction: Endoscopic surgery of the paranasal sinuses is a surgical technique that has revolutionized the surgical treatment of patients with chronic sinusitis. Application of this method now goes far beyond the conditions of the nasal cavity. Aim: It allows among other operations within the eye socket, acting alternative technique for the operation of the external appproauch. Material and Methods: This work is devoted to the analysis of the effectiveness of endoscopic surgery in the treatment of patients with orbital complications in the course of sinusitis in the Department of Otolaryngology SU in Cracow in the years 2004-–2016, aim of this study is to search for optimal treatment of patients with the above disorders. Results: In the group of patients operated on because of orbital abscess from reaching the outside in all patients had symptoms of revocation on the part of the orbit and ocular, and postoperative complications were not observed. Among patients undergoing endoscopic trocar in one patient there was no improvement in the function of the eye. It could lead to a too long period of time from the first appearance of symptoms (over 48 hours), and sometimes surgical intervention, as well as the occurrence of orbital hematoma in the second postoperative day and the necessity of re-operation of the external handle.

Introduction: Complication of an odontogenic infection to an orbital abscess is not a common presentation. The progression from a simple toothache to a condition that may lead to loss of vision is sudden and severe. Case Report: We report a rare case in which a patient developed facial cellulitis that progressed to orbital abscess after unsterile dental manipulation by a medical fraudster (“quack”). The patient was initiated on high-grade antibiotics, which resolved the facial cellulitis. However, the patient developed orbital abscess with restricted mobility of the right eye in the lateral gaze. After radiological confirmation of the abscess, it was drained by an external approach. Due to timely intervention, the extra-ocular mobility was regained, and the vision remained unaffected. Conclusion: Knowledge of the routes of the spread of dental infection to the vital structures and the urgent need for aggressive multidisciplinary management is paramount. Furthermore, awareness of the rising quack culture in developing nations needs to be increased.

Ruolo dell’approccio trans-palpebrale superiore endoscopico-assistito nella gestione delle complicanze infettive orbitarie multicompartimentali: considerazioni su 4 casi clinici.Gli ascessi dell’orbita rappresentano una delle più temibili complicanze in corso di rinosinusite acuta. La loro gestione è di tipo chirurgico nella maggior parte dei casi, con l’obiettivo di drenare la raccolta ed evitare l’evoluzione verso quadri ancora più seri che possano comportare la perdita della vista o l’estensione intracranica del processo infettivo. L’approccio chirurgico più frequentemente utilizzato è rappresentato dalla chirurgia endoscopica dei seni paranasali, pur risultando in alcuni casi insufficiente. Lo scopo del presente studio è quello di presentare la nostra esperienza nell’utilizzo dell’approccio trans-palpebrale superiore in combinazione con la via endoscopica endonasale classica nella gestione di casi selezionati di ascessi orbitari.Orbital abscess is one of the most serious complications of acute rhinosinusitis and requires surgical management to avoid further complications such as visual loss and intracranial extension of the infectious process. Endoscopic sinus surgery is the most frequently used procedure in such cases, even if its use may be insufficient in some cases. The aim of the present study is to present our experience on the management of selected orbital abscesses through a superior eyelid endoscopic approach in combination with endonasal surgery. Personal considerations on four cases and lessons learned are described.

Infectious sinusitis complications continue to be a frequent occurrence. These complications mostly occur in the orbital cavity or in the intracranial space. Most clinical reports indicate that, despite the near universal implementation of antipneumococcic conjugates vaccination, the incidence of these has been stable. The goals of this chapter will be to review the clinical manifestations of these infections, summarize the literature on best treatment practices, consider the effect of pneumococcal vaccines, describe changes in published bacterial pathogen profiles, and articulate expected outcomes of patients with these complicated infections.

Objective This review aims to investigate and compare the effectiveness of endoscopic drainage techniques against external drainage techniques for the treatment of orbital and subperiosteal abscesses as a complication of rhinosinusitis. Introduction Transnasal endoscopic drainage and external drainage techniques have been used in the management of subperiosteal orbital abscesses secondary to rhinosinusitis. Each of these approaches has its own advantages and disadvantages, with extensive literature describing each technique separately. However, there is a lack of guidance in the studies on assessing and comparing the safety, effectiveness and suitability of these techniques. This review aims to compare the effectiveness of these techniques based on measuring outcomes in the literature such as: length of postoperative hospital stay, rate of revision surgery and complication rates. Inclusion criteria Eligible studies will include people of all ages diagnosed with subperiosteal abscess, orbital abscess or cavernous sinus thrombosis (Chandler stages III-V) secondary to rhinosinusitis disease, who have also undergone drainage via either an endoscopic approach, external approach or combined surgical approach. Methods A comprehensive search of both published and unpublished literature will be performed to uncover studies meeting the inclusion criteria. Reference lists of studies included in final analyses will also be manually searched and subject matter experts contacted to investigate other sources of literature. Two reviewers will screen studies and a third reviewer will resolve disagreements. Studies will, where possible, be pooled in statistical meta-analysis with heterogeneity of data being assessed using the standard Chi-squared and I tests.

Pott’s puffy tumour (PPT) is a known complication of frontal sinusitis. It is defined as subperiosteal abscess formation due to osteomyelitis of the frontal bone presenting as a forehead swelling. It is a life-threatening condition that can lead to intracranial and intraorbital complications. Gadolinium-enhanced MRI and contrast CT scan are the best modalities to localise and define the collection, in addition to confirming disease extension. Once confirmed by imaging and depending on disease extension, management of PPT requires a multidisciplinary team approach and depends on the local provision of surgical care. Following surgical drainage of the abscess cavity, a prolonged course of antibiotics is required postoperatively to treat the underlying osteomyelitis.

INTRODUCTION: Subperiosteal orbital abscess (SPOA) is a serious suppurative complication of pediatric sinusitis. The objective of this study is to stratify patient selection into those best treated medically versus surgically based on clinical outcomes. METHODS: This is a retrospective review of patients diagnosed with SPOA complicating sinusitis treated at a tertiary care pediatric hospital from 2002 through 2016. SPOA was diagnosed by CT scan. Characteristics evaluated include demographics, abscess size, location, and measurements, length of hospital stay, medical and surgical interventions, presenting symptoms, and complications. RESULTS: A total of 108 total SPOA secondary to sinusitis patients were included. A majority, 72.2%, were male with an average age at presentation of 6.8 years. The mean ± standard deviation abscess cubic volume was 0.98 ± 1.27 cm(3) (median(range) = 0.44(0.01–7.34 cm(3))). With an abscess volume of .510cm(3), there was a sensitivity of 71.2% and a specificity of 84.4% for needing surgical drainage. Those with large abscesses at our volume threshold were 13 times more likely to require surgery than those with small abscesses, OR: 13.41, 95%CI: 5.02–35.86, p