Non-medial infectious orbital cellulitis: etiology, causative organisms, radiologic findings, management and complications

Seyed Mohammad Bagher Abtahi; Masoomeh Eghtedari; Shahla Hosseini; Mohammad Shirvani; Atefeh Talebi; Nasrin Masihpoor; Sahar Mohaghegh; Anahid Hamidianjahromi; Mohammad Hosseini

doi:10.1186/s12348-020-00213-3

Non-medial infectious orbital cellulitis: etiology, causative organisms, radiologic findings, management and complications

J Ophthalmic Inflamm Infect. 2020 Sep 7;10(1):22. doi: 10.1186/s12348-020-00213-3.

Authors

Seyed Mohammad Bagher Abtahi¹, Masoomeh Eghtedari¹, Shahla Hosseini¹, Mohammad Shirvani², Atefeh Talebi³, Nasrin Masihpoor⁴, Sahar Mohaghegh⁵, Anahid Hamidianjahromi⁶, Mohammad Hosseini¹

Affiliations

¹ Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
² Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. drshirvani69@gmail.com.
³ Biostatistician of Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran.
⁴ Infectious Ophthalmologic Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
⁵ Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical sciences and health services, Tehran, Iran.
⁶ Jahrom University of Medical Sciences, Jahrom, Iran.

Abstract

Background: Orbital cellulitis is an ophthalmic emergency, which is associated with vision-threatening adverse effects. The purpose of this study is investigating etiology, radiologic findings, management and complications of patients with non-medial orbital cellulitis.

Method: A retrospective medical record and radiologic file review of patients with infectious orbital cellulitis was performed to detect all patients with non-medial orbital cellulitis who referred to Khalili hospital from 2016 to 2019. Age, sex, origin of infection, size of collection or abscess, medical or surgical management, microbiology, first and final best-corrected visual acuity, duration of admission, and complications was recorded. Patients divided into two groups; medical management and surgical management groups and all of data compared between in this groups.

Results: Of ninety-six patients with infectious orbital cellulitis, 23 cases (14 male, 9 female) were included. Five patients (21.7%) were managed medically and 18 patients (78.3%) were managed surgically. Patients' age range was 5-70 years old. Most common location for non-medial cellulitis was superior space (66.7% in surgical and 40% in medical group; p = 0.511). In 13 cases of surgical group (72.3%) were detected microorganisms. The mean ± SD of collection volume in medical group were 476.5 ± 290.93 mm³ and 2572.94 ± 1075.75 mm³ in surgical group (p < 0.001). Ten patients in surgical group had compressive optic neuropathy. The mean ± SD of collection volume was 3204.97 ± 879.88 mm³ in patient with compressive optic neuropathy and 1280.43 ± 880.68 mm³ in patient without compressive optic neuropathy (P < 0.001). One case complicated by subdural empyema and another case progressed to necrotizing fasciitis.

Conclusion: Non-medial orbital cellulitis is an uncommon but sight-threatening and life-threatening condition. Timely diagnosis and accurate management reduce morbidity and mortality. Combined surgery for patients with superior or supra-temporal and large non-medial abscess is recommended.

Keywords: Complication; Orbital cellulitis; infection; Sinusitis; Subperiosteal abscess.