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
Natural History
Complications
Complications that can develop as a result of orbital cellulitis are:
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
Prognosis by type of infection
Prognosis by complications
The feared complications include cavernous sinus thrombosis and meningitis. Abscess formation is another complication and may require surgical drainage.Complications include hearing loss, blood infection, meningitis, and optic nerve damage (which could lead to blindness).Although orbital cellulitis is considered an ophthalmic emergency the prognosis is good if prompt medical treatment is received.
Death and Blindness Rates without Treatment
Bacterial infections of the orbit have long been associated with a risk of catastrophic local sequelae and intracranial spread.
The natural course of the disease, as documented by Gamble (1933), in the pre-antibiotic era, resulted in death in 17% of patients and permanent blindness in 20%.