Orbital complications secondary to acute sinusitis– A 10 years retrospective review

Abstract

Abstract

Introduction: Orbital complication may accompany acute sinusitis in all age, commonly preseptal or orbital cellulitis.

Aim: To evaluate the clinical presentation, management, and outcome of orbital complications of sinusitis in patients treated at our institution.

Methods: A case study of retrospective review of 10 patients with orbital complications secondary to acute sinusitis was conducted in our centre over a 10-years period. The clinical presentation, relevant investigations, management and outcome were analysed.

Results: Most of the patients were children. The most common diagnosis was subperiosteal abcess (SPOA) in five patients (50%), followed by two cases each of preseptal cellulitis, and orbital cellulitis and one of orbital abscess. CT scan plays a major role in diagnosis as well as monitoring the disease. Surgical drainage is recommended in managing orbital abcess, but we highlight one case of a small orbital abscess which was successfully managed with conservative.

Conclusion: The clinical examination alone is not always helpful and therefore a CT scan is useful to diagnose and monitor the extent of the intraorbital infection. Medical treatment has an important role not only in preseptal and orbital cellulitis, but also in SPOA and small orbital abcess.

Keywords

• Orbital cellulitis, paranasal sinus disease, sinusitis, endoscopy

References

1. Mortimore S, Wormald PJ, Oliver S. Antibiotic choice in acute and complicated sinusitis. J Laryngol Otol 1998; 112: 264-268.
2. Ali A, Kurien M, Mathews SS, Mathew J. Complications of acute infective rhinosinusitis: experience from a developing country. Singapore Med J 2005; 46: 540-544.
3. Tshifularo M, Monama G.M. Complications of inflammatory sinusitis in children: institutional review. SA Fam. Pract 2006; 48: 16a-16c.
4. Fireman P. Diagnosis of sinusitis in children: emphasis on the history and physical examination. J Allergy Clin Immunol 1992; 90: 433-436.
5. Wald ER. Sinusitis in children. N Engl J Med 1992; 326: 319-323.
6. American Academy of Pediatrics. Subcommittee on Management of Sinusitis and Committee on Quality Improvement. Clinical practice guideline: management of sinusitis. Pediatrics 2001; 108: 798- 808.
7. Chandler JR, Langenbrunner DJ, Stevens ER. The pathogenesis of orbital complications in acute sinusitis. Laryngoscope 1970; 80(9):1414-1428.
8. Osguthorpe JD, Hochman M. Inflammatory sinus diseases affecting the orbit. Otolaryngol Clin North Am 1993; 26: 657-671.

9. Krohel GB, Krauss HR, Winnick J. Orbital abscess. Presentation, diagnosis, therapy, and sequelae. Ophthalmology 1982; 89: 492-498.
10. Gutowski WM, Mulbury PE, Hengerer AS, Kido DK. The role of C.T. scans in managing the orbital complications of ethmoiditis. Int J Pediatr Otorhinolaryngol 1988; 15: 117-128.
11. Graham J.M, Scadding G.K, Bull P.D. Pediatric ENT, Springer-Verlag 2007; 307–325.
12. Spires JR, Smith RJ. Bacterial infections of the orbital and periorbital soft-tissues in children. Laryngoscope 1986; 96: 763-767.
13. Souliere C.R, Antoine G.A, Martin M.P, et al. Selective non-surgical management of subperiosteal abscess of the orbit: computerized tomography and clinical course as indication for surgical drainage. Int. J. Pediatr. Otorhinolaryngol 1988; 15: 117-128.
14. Rubin SE, Rubin LG, Zito J, Goldstein MN, Eng C. Medical management of orbital subperiosteal abscess in children. J Pediatr Ophthalmol Strabismus 1989; 26: 21-27.
15. Garcia GH, Harris GJ. Criteria for nonsurgical management of subperiosteal abscess of the orbit: analysis of outcomes 1988-1998. Ophthalmology 2000; 107: 1454-1456.
16. Harris GJ. Subperiosteal abscess of the orbit. Age as a factor in the bacteriology and response to treatment. Ophthalmology 1994; 101: 585-595.
17. Ikeda K, Oshima T, Suzuki H, et al. Surgical treatment of subperiosteal abscess of the orbit: Sendai's ten-year experience. Auris Nasus Larynx 2003; 30: 259-262.
18. Lu CH, Chang WN, Lui CC. Strategies for the management of bacterial brain abscess. J Clin Neurosci 2006; 13: 979-985.
19. Barling RW, Selkon JB. The penetration of antibiotics into cerebrospinal fluid and brain tissue. J Antimicrob Chemother 1978; 4: 203-227.
20. Brook I. Treatment of anaerobic infection. Expert Rev Anti Infect Ther 2007; 5: 991-1006.
21. Brook I. Microbiology and antimicrobial treatment of orbital and intracranial complications of sinusitis in children and their management. Int J Pediatr Otorhinolaryngol 2009; 73: 1183-1186.
22. Sinclair CF, Berkowitz RG. Prior antibiotic therapy for acute sinusitis in children and the development of subperiosteal orbital abscess. Int J Pediatr Otorhinolaryngol 2007; 71: 1003-1006.
23. Brooks I, Gooch WM 3rd, Jenkins SG, et al. Medical management of acute bacterial sinusitis. Recommendations of a clinical advisory committee on pediatric and adult sinusitis. Ann Otol Rhinol Laryngol Suppl 2000; 182: 2-20.