Orbital cellulitis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [2]
Overview
If left untreated, orbital cellulitis may result in blindness in 20% of patients and death in 17%. Complications that can develop as a result of orbital cellulitis include abscess, orbital compartment syndrome, intracranial extension of infection, and septic shock. Although orbital cellulitis is considered an ophthalmologic emergency, the prognosis is good if prompt medical treatment is received. Depending on the extent of complications at the time of diagnosis, prognosis may vary. The most serious complications include septic shock, cavernous sinus thrombosis, and meningitis. These complications carry a poor prognosis.[1][2][3][4][5]
Natural History
If left untreated, orbital cellulitis may result in death in blindness in 20% of patients, and death in 17%.[1]
Complications
Complications that can develop as a result of orbital cellulitis are:[2][3][4]
Abscess
Abscesses are a common complication of orbital cellulitis. The most commonly encountered abscesses in this scenario are:
- Subperiosteal abscess
- Orbital abscess
Orbital compartment syndrome
Orbital compartment syndrome is among the most serious complications of orbital cellulitis and has a high risk of causing permanent vision loss. In orbital cellulitis cases, it occurs due to compression of the ophthalmic vasculature or optic nerve by a growing abscess, or uncontrolled infection in the retrobulbar region.
Intracranial extension
Intracranial extension of orbital cellulitis is among the most serious complications; it may result in encephalitis, meningitis, or sepsis.
Cavernous sinus thrombosis
Cavernous sinus thrombosis is among the most common causes of death due to orbital cellulitis; it occurs secondary to bacterial colonization causing venous stasis.
Septic shock
Bacteremia and sepsis may result from a sustained infection of orbital cellulitis. Sepsis carries a high risk of mortality.
Prognosis
Depending on the time of diagnosis, the prognosis may vary. Although orbital cellulitis is considered an ophthalmic emergency, the prognosis is good if prompt medical treatment is received.[5] In some cases, surgical intervention is required to mitigate serious complications. Undergoing surgical intervention for orbital cellulitis is associated with longer hospital admissions.[4]
The most serious complications include septic shock, cavernous sinus thrombosis, and meningitis. These complications carry a poor prognosis. Abscess formation is another complication that may require surgery. Complications secondary to abscess formation include bacteremia and optic nerve damage. which may lead to permanent vision loss. [2][3]
References
- ↑ 1.0 1.1 "Reorganized text". JAMA Otolaryngol Head Neck Surg. 141 (5): 428. 2015. doi:10.1001/jamaoto.2015.0540. PMID 25996397.
- ↑ 2.0 2.1 2.2 Bedwell J, Bauman NM (2011). "Management of pediatric orbital cellulitis and abscess". Curr Opin Otolaryngol Head Neck Surg. 19 (6): 467–73. doi:10.1097/MOO.0b013e32834cd54a. PMID 22001661.
- ↑ 3.0 3.1 3.2 Healy GB (1997). "Chandler et al.: "The pathogenesis of orbital complications in acute sinusitis." (Laryngoscope 1970;80:1414-1428)". Laryngoscope. 107 (4): 441–6. PMID 9111370.
- ↑ 4.0 4.1 4.2 Ryan JT, Preciado DA, Bauman N, Pena M, Bose S, Zalzal GH; et al. (2009). "Management of pediatric orbital cellulitis in patients with radiographic findings of subperiosteal abscess". Otolaryngol Head Neck Surg. 140 (6): 907–11. doi:10.1016/j.otohns.2009.02.014. PMID 19467413.
- ↑ 5.0 5.1 Lee S, Yen MT (2011). "Management of preseptal and orbital cellulitis". Saudi J Ophthalmol. 25 (1): 21–9. doi:10.1016/j.sjopt.2010.10.004. PMC 3729811. PMID 23960899.