Home Ophthalmology Orbital Cellulitis
Clinical History
Examination
Investigations
Diagnosis
Treatment
Discussion
References

55 year old blind lady with complaints of pain, swelling and watering of the right eye since 10 days

  • Associated with fever, nausea and vomiting since 10 days
  • Known case of Diabetes Mellitus since 8 years and Hypertension since 20 years on medication

Local Examination:
Right Eye:

  • Swelling of the eyelid with erythematous and tender with restricted movements.
  • Proptosis of the eyeball with restricted movements.
  • Conjunctiva is chemosed and congested.
  • Cornea-irregular surface with opacity, decemetocoele
  • Pupil and Lens not visible.

Systemic Examination:
CNS, CVS and RS: Normal

Microbiology (Pus):
Gram stain:
Inflammatory Cells: Plenty in number
Organisms:
Gram positive cocci in pairs and singles.
KOH: No Fungal elements.

Plain CT On Paranasal Sinuses:
-Right periorbital and orbital cellulitis.
-Pansinusitis


-Right periorbital and orbital cellulitis.
-Pansinusitis

Investigations
Biochemistry
Urea: Normal
Creatinine: Elevated
Sodium: Decreased
Potassium: Normal
HbA1C and RBS: Elevated.

Haemotology:
Normocytic Normochromic Anemia with Increased Neutrophills.

Right sided orbital cellulitis,
corneal ulcer,
Panophthalmitis


Uncontrolled Diabetes with Diabetic Nephropathy

Parenteral Antibiotics: Ceftriaxone and
Metronidazole

Other Medications:
Insulin for optimal Sugar control and Antihypertensives.

Topical Application:
Atropine
Fortified Ceftazidine

In view of progressive infection leading to panophthalmitis, patient was subjected to Evisceration.

[Evisceration is surgical removal of the contents of the eyeball including the sclera].

Orbital cellulitis may result from extension of infections of the neighbouring structures like the paranasal sinuses(1),trauma to the eye, upper respiratory infection,

Causative organisms:
Streptococcus pneumoniae, Staphylococcus aureus, Streptococcus pyogenes.

Immediate treatment with topical and parenteral antibiotics is necessary to prevent complications like loss of vision, exposure keratopathy, optic neuritis, subperiosteal abscess, orbital abscess,cavernous sinus thrombosis, meningitis, brain abscess,(2)

Panopthalmitis is the intense inflammation of the whole eyeball including the Tenon’s capsule necessitating eviseration. (3)

Although Orbital cellulitis is an emergency, prognosis is good if prompt treatment is given. (4)

  1. Chandler JR, Langenbrunner DJ, Stevens ER. The pathogenesis of orbital complications in acute sinusitis. The Laryngoscope. 1970 Sep;80(9):1414-28.
  2. Jackson K, Baker SR. Clinical implications of orbital cellulitis. The Laryngoscope. 1986 May;96(5):568-74.
  3. Shahan WE. Panophthalmitis, evisceration, sympathetic ophthalmia. American Journal of Ophthalmology. 1927 Feb 1;10(2):120-3.
  4. Schramm Jr VL, Curtin HD, Kennerdell JS. Evaluation of orbital cellulitis and results of treatment. The Laryngoscope. 1982 Jul;92(7):732-8

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