| Print Date: | June 19, 2013, 8:03 pm |
| Title | Ethmoiditis with subperiosteal abscess of the left medial orbit |
| Text | Abscesses and orbital cellulitis are characterized by massive accumulation of PMNs. Causative agent can usually be demonstrated with staining following aspiration or surgical drainage. These usually occur in conjunction with adjacent sinusitis but may also occur after orbital trauma or with systemic infections. Offending pathogens include a variety of bacterial, viral, fungal, and parasitic etiologies, however, most cases arise from bacterial infections of the sinuses. These bacterial pathogens in children include those of typical URI etiologies such as S. Pneumoniae, H. Influenza and S. Aureus. Pseudomonas and E. Coli are also less common causes of orbital cellulitis.
Patients typically present with the sudden onset of pain, eyelid edema, conjunctival hyperemia and chemosis and sometimes proptosis, diplopia, increased IOP, and blepharoptosis. Orbital cellulitis is one of the most common causes of proptosis in children less than five. Patients may also experience fever, malaise, and leukocytosis with signs of sinusitis. Subperiosteal abscess is a purulent collection within the adjacent subperiosteal space that can lead to abaxial displacement, local tenderness, and a possible fluctuant mass. Abscess formation may be rapid with destruction of tissue planes depending on the severity of the offending pathogen. Clinical clues may include profound proptosis with a functional deficit in the absence of striking concomitant inflammatory signs such as chemosis and lid injection. Typical CT features of a subperiosteal abscess include (+/-) an enhancing capsule with smooth contoured periorbital lesion adjacent to an opacified sinus. Cellulitis would appear as lid edema, sinus opafication with mucosal thickening. Following contrast infusion, periosteum may be seen to enhance therefore giving rise to an enhancing capsule as seen in this patient. Complications include severe septicemia with resultant meningitis and cavernous sinus thrombosis; however, with the institution of immediate incision and drainage with appropriate IV antibiotics fatal outcomes have dropped dramatically in the past decade. Cavernous sinus thrombosis would present with headache, nausea, vomiting, fever, and varying levels of consciousness in addition to the typical signs and symptoms of orbital cellulitis. Patients should be monitored while hospitalized for worsening symptoms despite antibiotic treatment in order to prevent these fatal outcomes. |
| References: | Mafee MF, Mafee RF, Malik M, Pierce J, “Medical Imaging in Pediatric Ophthalmology”, Pediatric Clinics of North America, Feb 2003; 50(1): 259-86.
Nelson, Leonard B. Pediatric Ophthalmology, WB Saunders Co. 1998, pp 177-178. Rootman, Jack. Diseases of the Orbit, JB Lippincott Co., 1988, pp144-152. Shields, Jerry A. Diagnosis and Management of Orbital Tumors, WB Saunders Company 1989, pp 67-69. Yanoff, Ophthalmology 2nd Edition, Mosby 2004, pp 738-739. |
| Contributor | Russell A. Patterson (Uniformed Services University) |
| Author | 2d Lt Kristine Pierce |
| Peer Reviewer | James G. Smirniotopoulos, M.D. (Uniformed Services University) |
| Record Number | : 6348 |
| Created | 2005-02-22 08:12:04-05 |
| Modified | 2005-03-10 12:55:36.484116-05 |
| Category: | Ophthalmology |
| Location: | Eye and Orbit (exclude Ophthalmology) |
| Sublocation: | Extraconal |
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