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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]

Orbital cellulitis is an infection of the orbital soft tissues posterior to the orbital septum. It has the potential to be affect sight and function of the eye and extraocular tissues. Although it is commonly seen in the pediatric age group, adult orbital cellulitis is not uncommon. Infection usually originates from sinuses but sometimes the nidus of infection is in the eyelids, from retained vegetative foreign bodies, or very rarely from distant infection spreading to the orbit spread from blood. It is characterized by pain, proptosis, chemosis, diminution of vision, fever, periorbital erythema, and limitation of ocular motility. Historically orbital cellulitis was a sight and life-threatening condition. However, with the advent of high quality imaging, antibiotics and early surgical intervention to drain the orbital abscess when indicated, the chances of visual loss have reduced significantly. The purpose of this review is to describe current investigative and management paradigms in the treatment of orbital cellulitis and current recommendation in the management of complications resulting from it.

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]

Subperiosteal abscess is a condition that typically presents as collection of pus in the space between the periorbital and the lamina papyracea as a result of the migration and spread of an infection, such as sinusitis and ethmoiditis. The low incidence requires a high index of suspicion to be considered in the differential diagnosis when encountering this life-threatening illness. This case highlights the significance of a prompt and accurate diagnosis for this infrequent condition, because it may progress to blindness, meningitis, intracranial abscess, and death. We present evidence to address the controversies of two approaches, immediate surgical drainage of the abscess versus more conservative pharmacologic medical treatment. [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]

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.

Purpose: We describe this case and review the literature, to allow this to be a cautionary tale in the interpretation of fluid collections in the setting of spontaneous globe subluxations (GS). Observations: A 58 year old female, with a past medical history of globe subluxation, was diagnosed radiographically with an orbital abscess, and managed with an orbitotomy. However, no abscess was identified operatively and subsequent imaging showed only extravasation of serous fluid. Conclusions and importance: We postulate that in the case here, the fluid collection posterior to the globe was in fact due to increase venous congestion and decrease venous return posteriorly from the globe to the cone, leading to an efflux of clear serous fluid. We postulate that in the case of GS without other clinical indications suggesting orbital abscess one can consider a posterior globe collection of fluid to be an extravasation of serous fluid, secondary to increased venous congestion.

Purpose: This is a case report of an unusual case of the family transmission of Streptococcus pyogenes infection in three siblings. One brother contracted the infection which resulted in orbital cellulitis of two of his siblings, in the absence of anatomical or immunological predisposing factors. Observations: A young boy contracted an uncomplicated S pyogenes upper respiratory tract infection. The twin brother closely followed by the older sister both developed a S pyogenes orbital cellulitis a couple of days later. Conclusions and importance: To our knowledge, this is the first case ever reported of family transmission of orbital cellulitis. This highlights the importance of early diagnosis and treatment of S pyogenes, and the role of throat cultures as means of diagnosis even in the absence of symptoms or signs of pharyngitis.

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]

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. [ABSTRACT FROM AUTHOR]

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

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

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.

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]

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

Introduction The management of orbital abscesses in neonates and infants is very challenging. Surgical drainage of the abscess is aimed at removing the pus and preventing blindness. We describe a case of orbital abscess in an infant that was caused by methicillin-resistant Staphylococcus aureus and that was successfully drained with image-guided endoscopic surgery. Presentation of case A 39-day-old infant presented with progressive right maxillary swelling complicated by methicillin-resistant Staphylococcus aureus orbital abscess. Tooth bud abscess was the most likely primary cause and a combination of intravenous antibiotics was initially prescribed. The collection of intra-orbital pus was removed using image-guided system-aided endoscopic surgical drainage. Discussion Prompt diagnosis and management are very crucial. Endoscopic drainage of these abscesses in children has been described. Image-guided drainage of the orbital abscess is a newer technique that has been reported in a teenager and in adult patients. This is the first reported case of endoscopic orbital drainage surgery in an infant. The procedure was performed successfully. This approach provides for better identification of the anatomical structures in a very young patient. Injuries to the medial rectus, globe and optic nerve can be avoided with this technique. Conclusion Aggressive management of orbital abscesses in infants is mandatory. Image-guided endoscopic orbital drainage offers precise visualization and a safer technique in a relatively smaller orbit. [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]

Orbital complications are the second most common complications of endoscopic sinus surgery (ESS), and orbital hematoma is the most frequent orbital complication. An orbital abscess is usually associated with rhinosinusitis, and a few cases of orbital abscesses occurring after orbital trauma have been reported. However, orbital abscess occurring after ESS is rare. Herein, we present a case of a right orbital abscess that developed after bilateral ESS, performed at an outside facility, and decreased vision in the right eye to light perception only. The visual loss persisted for 3 days, after which the patient was referred to our hospital for urgent management. The cause of abscess formation might have been an infected stagnant orbital venous hematoma that occurred as a complication of ESS. A defect in the right lamina papyracea and emphysema were confirmed on computed tomography. Orbital symptoms started immediately after ESS, and vision deteriorated to light perception only and lasted for 3 days, which was considered a high-grade risk factor for irreversible blindness by the ophthalmology team. Urgent endoscopic endonasal orbital decompression was performed to drain the orbital abscess, and maximal medical treatment was initiated, which included intravenous corticosteroids, intravenous broad-spectrum antibiotics, topical intranasal corticosteroids, irrigation, and topical antibiotic eye drops. Close follow-up assessments were performed by the infectious diseases team, and the ophthalmology team performed frequent orbital assessments. The patient recovered from blindness, which was an unexpected outcome., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

A seventeen-year-old girl was admitted to our clinic with complaint of rubor, swelling, and pain on the left upper eyelid. Her medical history revealed that she had received high-dose oral steroid treatment for one week for the diagnosis of acute angioedema in another clinic. On ophthalmologic examination, her left upper eyelid had edema, swelling, and hyperemia. Additionally, she had restriction in up-gaze in the left eye. Her best-corrected visual acuity was 0.7. The patient’s computerized tomography revealed ethmoidal, maxillary and frontal sinusitis, as well as subperiostal orbital abscess, and frontal epidural abscess. Intravenous antibiotic treatment has been arranged. Due to persistence of the clinical signs, surgical drainage of the abscesses has been performed. Following, she has been discharged from the hospital on oral antibiotic treatment. Postoperatively, at the first-month visit, the left eye’s up-gaze restriction was recovered, and visual acuity was improved to 1.0. If a patient presents with eyelid swelling, differential diagnosis should be performed carefully before making the decision to start steroid treatment. Sinusitis, which is seen frequently in clinical practice, should be kept in mind due to its potential to cause orbital abscess, epidural abscess, and intracranial complications. (Turk J Ophthalmol 2013; 43: 464-7

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

We present the case of a retrobulbar abscess that developed secondary to the repair of an oroantral communication. Orbital abscesses have been described in relation to odontogenic infections, facial injury, sinusitis, and after dental extractions but, to the best of our knowledge, none has been reported in these circumstances. Retrobulbar abscess is a rare complication, but early clinical and radiological diagnosis, and urgent decompression are vital because it comes with considerable risk of irreversible visual impairment. [ABSTRACT FROM AUTHOR]