Orbital Cellulitis

BackgroundThis case illustrates the importance of prompt assessment and treatment of orbital cellulitis. In fact the ocular signs and symptoms may be associated with systemic complications which should be investigated and identified as soon as possible to avoid a poor prognosis.Case presentationA 46-year-old white woman presented to our emergency room with proptosis, ophthalmoplegia, and conjunctival chemosis of her left eye. An ophthalmologist, having diagnosed orbital cellulitis in her left eye, suspected a cavernous sinus thrombosis. Hematochemical and radiological examinations confirmed the cavernous sinus thrombosis and also showed septic pulmonary embolism. A blood culture indicated Streptococcus constellatus, which is a member of the Peptostreptococcus family, a saprophyte of the oral mucosa that can be pathogenic in immunocompromised persons. The odontogenic origin was then confirmed by dental radiography which showed a maxillary abscess. Her eye signs regressed after antibiotic and anticoagulant therapy.ConclusionsThis complex case shows the importance of a multidisciplinary approach for the management of orbital cellulitis, for the prompt diagnosis and treatment of eye injuries and possible complications, so as to avoid serious and permanent sequelae.

This work describes a series of patients with odontogenic orbital cellulitis (OOC), focusing on rate of abscess formation, need for surgical intervention, and imaging findings helpful for rapid diagnosis. Review of a current case and 22 patients with OOC from the scientific literature demonstrated periapical lucency as the most commonly (36.4%) reported finding on facial and orbital computerized tomography (CT) scan. Orbital abscess occurred in 72.7% of cases, and tooth extraction and/or abscess drainage was required in 95.5% of cases reviewed for control of infection. The current case presented with periapical lucency on CT scan, developed orbital abscess despite broad spectrum antibiotic therapy, and required multiple surgical interventions for disease resolution. Though our patient regained excellent vision, OOC often can result in severe vision loss. Periapical lucency on CT can help identify this atypical origin of cellulitis that is strongly associated with abscess formation and need for surgical intervention.

IntroductionThe standard management of orbital cellulitis is to administer a combination of intravenous broad-spectrum antibiotics along with treatment of associated sinusitis.ObjectiveThe purpose of this study was to evaluate whether the addition of corticosteroids could lead to earlier resolution of inflammation and improve disease outcome.MethodsWe independently searched five databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) for studies published as recent as December 2019. Of the included studies, we reviewed orbital cellulitis and disease morbidity through lengths of hospitalization, incidence of surgical drainage, periorbital edema, vision, levels or C-reactive protein, and serum WBC levels in order to focus on comparing steroid with antibiotics treated group and only antibiotics treated group.ResultsLengths of hospitalization after admission as diagnosed as orbital cellulitis (SMD=-4.02 [-7.93; -0.12], p-value=0.04, I2=96.9%) decrease in steroid with antibiotics treated group compared to antibiotics only treated group. Incidence of surgical drainage (OR=0.78 [0.27; 2.23], p-value=0.64, I2=0.0%) was lower in the steroid with antibiotics treated group compared to the antibiotics only treated group.ConclusionUse of systemic steroids as an adjunct to systemic antibiotic therapy for orbital cellulitis may decrease orbital inflammation with a low risk of exacerbating infection. Based on our analysis, we concluded that early use of steroids for a short period can help shorten hospitalization days and prevent inflammation progression.

IntroductionOrbital cellulitis is primarily a pediatric disease; although distinct from periorbital cellulitis, presenting symptoms may overlap, creating a challenge in diagnosis. If untreated, it can result in severe complications such as vision impairment, intracranial infection, cavernous sinus thrombosis (CST), and death. We created a simulation course to teach pediatric residents to recognize and treat this important diagnosis and its life-threatening complications.MethodsThis simulation features a 10-year-old patient who presents with eye pain and swelling due to orbital cellulitis. Learning objectives include recognizing and managing orbital cellulitis, identifying sequelae of orbital cellulitis (eg, CST), and liaising with surgical and intensive care consultants. Facilitators led a postsimulation debrief and didactic session, and participants completed an anonymous postcourse evaluation. The entire session took 60 minutes.ResultsThis simulation was performed 4 different times, involving a total of 27 participants, all of whom were pediatric residents. Twenty-three participants completed the postcourse survey. The average overall course was rated 5.7/6, and participants reported that the knowledge gained from the session will be helpful to them in their practice and will help improve patient outcomes (mean = 3.9/4).DiscussionOur simulation was well received by participants and provided them with an opportunity to learn how to manage a highly morbid complication of orbital cellulitis, a common pediatric condition. This educational session can be completed in an hour and requires no advanced preparation for participants. This simulation can be adapted to run in a low-fidelity environment across a range of medical subspecialty training programs.