Visual Diagnosis of Orbital Cellulitis

A 4-year-old girl presented with worsening swelling, overheating, and slight reddening of the right eye. This had had been present for 2 days and was accompanied by a fever which had been present for 5 days. Her clinical history included an infection of the upper airways accompanied by fever, which had been treated symptomatically 2 weeks earlier. Laboratory testing revealed a CRP level of 86 mg/L. Slit-lamp examination findings were normal. An orbital complication was suspected, so an emergency unenhanced CT scan of the orbit and paranasal sinuses was performed. Imaging revealed a preseptal phlegmonous change in the right orbit with a narrow subperiosteal abscess in an intraorbital, medial location, in the context of pansinusitis. After surgical removal and opening of the ethmoidal cells, intravenous ampicillin/sulbactam therapy was initiated, followed by oral cefpodoxime for 14 days. The girl was able to open her eyes again on the third day of inpatient treatment. Recovery was complete. Orbital cellulitis is a dangerous, rare, swiftly progressing disease that usually occurs in children, including small children. It is often caused by sinusitis or ethmoiditis and can more rarely be caused by an infected chalazion/stye, odontogenic tissue, intraorbital foreign bodies, periorbital skin trauma, or dacryocystitis. The main clinical signs are chemosis, conjunctival hyperemia, pain, swelling of the eyelids, exophthalmos, eye motility problems, and diplopia/loss of vision. It entails the risk of cavernous sinus thrombosis, blindness, and sepsis.

Translated from the original German by Christine Rye.

Cite this as: Bachmann S, De Laffolie J, Zimmer KP: Visual diagnosis of orbital cellulitis..

Figure.

a) Reddening of the right eye with swelling of the eyelids, rhinorrhea, tenderness of the tragus, and right-side cervical lymphadenopathy. b) Unenhanced CT using soft tissue window, showing right orbit with medially emphasized preseptal swelling of the soft tissues and slight suppression of the medial extraconal soft tissues, just reaching the posterior ethmoidal cells (arrow)