Thomas Spoor, MD
  • 27450 Schoenherr Road, Warren, Michigan,48088
    586-582-7860
  • 3400 Bee Ridge Road, Sarasota, Florida,34239
    941-921-5335
Procedures

Orbital Infections

Mucormycosis

  • Mucormycosis is a fulminant oportunisitic fungal infection caused by fungi of the class Zygomycetes.
  • PredisORALsing factors: patients who have diabetic ketoacidosis or who are immunocompromised
  • Etiology: Infection begins in the paranasal sinuses and spreads to the orbit. The large, nonseptate hyphae cause vascular occlusion. This causes ischemia and infarction of tissue.
  • Therapy: includes correction of the underlying metabolic abnormality and debridement of all involved infected tissue. It may possibly require orbital and sinus exenteration, coupled with both systemic and local treatment with Amphotericin B
  • Adjunct therapy: hyperbaric oxygen therapy may possibly be beneficial

Orbital cellulitis

  • infectious inflammatory process involving the orbital tissues posterior to the orbital septum and requires
  • Etiologies include trauma, orbital fracture repair, strabismus surgery
  • Extension of pre-existing infections of the face, lacrimal sac, and lacrimal gland which can extend into the orbit
  • Pathophysiology: The most common bacterial pathogens in preseptal cellulitis include Haemophilus influenza, Staphylococcus aureus, and Streptococcus pneumoni
  • Therapy: Subperiosteal abscess formation should be suspected if patients fail to improve or deteriorate on intravenous antibiotics .
    • Infants with preseptal cellulitis are usually admitted for intravenous therapy, whereas
    • older children and adults with preseptal infections may possibly be treated with oral antibiotics. 7- to 10-days of intravenous therapy are required, followed by a course of oral antibiotics for 10 to 14 days
  • infection posterior to orbital septum
  • 90% from extension of acute or chronic bacterial sinusitis, remainder s/p trauma or surgery or 2o to extension from other orbital or periorbital infection, or endogenous w/septic embolization
  • fever, proptosis, restriction of EOM’s, pain on globe movement
  • decreased visual acuity Afferent Pupillary Defect (APD), prolonged high Intraocular pressure (IOP) can be indications for aggressive management to prevent orbital apex syndrome or cavernous sinus thrombosis

Orbital cellulitis

  • CT of orbit and sinuses to confirm sinus disease, rule out mass, rule out orbital foreign body if h/o trauma (even remote), rule out orbital or subperiosteal abscess which will require surgical drainage
  • blood culture then broad spectrum IV antibiotics to cover gram cocci, H. influenzae (although less prevalent in kids 2o to immunization), anaerobes, typically nafcillin and 3rd generation cephalosporin; ID consult if necessary; kids more often single organism
  • progression of infection or no daily improvement on appropriate antibiotics can mean abscess: repeat CT as needed (prn) and drain w/concomitant sinus drainage as needed (prn)
  • cavernous sinus thrombosis: rapid progression of proptosis and neurologic signs of intracranial dysfunction; may possibly lead to meningitis; get neurosurgery consult
Clinical Photo of a patient with a subperiosteal abscess CT of a patient with a subperiosteal abscess

 

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