Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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July 13, 2009
Orbital Cellulitis and Subperiosteal Abscess
- Orbital cellulitis represents a group of conditions ranging from periorbital inflammation to subperiosteal and orbital abscess to cavernous sinus thrombosis.
- Chandler classification system: I, inflammatory edema (preseptal cellulitis); II, Orbital cellulitis; III, Sub Periosteal abscess; IV, Orbital abscess, and V, cavernous sinus thrombosis.
- Orbital Cellulitis commonly results from acute sinusitis & can lead to disastrous outcomes if not appropriately treated. In presence of ethmoiditis, the infection spreads through the lamina papyracea (through the orbital floor in maxillary sinusitis and the roof of the orbit in frontal sinusitis). Other potential routes include local thrombophlebitis, or by way of infected emboli. As it progresses, it can lead to subperiosteal or orbital abscess.
- Other less common etiologies include dacryocystitis, retained orbital foreign body, periocular trauma and dental infection.
- CT/ MRI show enhancing subperiosteal soft tissue with or without fluid collection , bone erosion and paranasal sinus fluid levels. Depending on the location of the abscess, the extra ocular muscles are displaced contra laterally.
