Orbital cellulitis - A complication of sinusitis

Kathmandu University Medical Journal (2005) Vol. 3, No. 3, Issue 11, 292-293
Case Note
Orbital cellulitis - A complication of sinusitis
Lavania A1, Sharma V2, Reddy NS3, Baksh R4
1, 4Lecturers, 2Assistant Professor, 3Professor and HoD, Department of ENT, Manipal Teaching Hospital, Pokhara


Abstract
A 9 years old patient presented with swelling and severe pain in right eye with diplopia; with normal visual acuity.
CT scan of paranasal sinus revealed right eye axial proptosis and dehiscence in lamina papyracia. After thorough
investigation, patient was posted for surgical drainage and decompression of the right orbit. Patient, improved after
surgery and followed regularly for last 2 months.

Key word: Orbital cellulitis- A complication of sinusitis.


omplications associated with sinusitis may
antrostomy was performed to clear maxillary sinus
C broadly be divided into acute and chronic or disease. Diseased mucosa and pus was sent for
local and distant. Local acute complications are by
histopathologic examination and culture and
far the more common and may broadly be
sensitivity respectively. Drain was placed in post
categorized as orbital, intracranial and bony. Orbital
operative cavity. After completion of the procedure,
complications of sinusitis most frequently affect the
haemostasis was confirmed. Wound was closed in
young with 85% under 20 years and 50% or more
two layers and ribbon gauge soaked in antibiotic
being under 6 years of age2. Complications in
ointment was packed in both nasal cavity. On 2nd and
children are most frequently due to ethmoiditis in
6th day, nasal pack and sutures were removed
absence of frontal sinus development3 and in adults
respectively. Patient improved and was discharged on
frontal sinus is the frequent culprit.
7th post operative day after removal of drain.


Case Report
Discussion
9 year old male child presented to casualty with right
Orbital complication of sinusitis are common in the
eye swelling, pain and diplopia since one week.
young under 20 years of age. Curiously the left orbit
Swelling of right eye started 3 days after common
has consistently been shown to be more frequently
cold, followed by dull aching pain, which was
affected4. Incidence of orbital complications
localized, continuous, progressive and associated
secondary to sinusitis has been reported at between
with diplopia. There was no history of diminution of
21 and 90%3. The frequency appear to be higher
vision. E.N.T examination showed mucopurulent
during the winter and spring5.
discharge in middle meatus and oedematous mucosa

over middle turbinate, while ophthalmologic

examination was done to assess displacement of the

globe, ocular movement and most importantly visual

acuity. There was axial proptosis with restricted

ocular movements and visual acuity was normal. CT

scan (coronal and axial cut) of paranasal sinus

showed right ostiomeatal complex disease, dehiscent

lamina papyracea and mild axial proptosis. Board

spectrum I.V. antibiotic and nasal decongestant were


administred. Patient was posted for combined

approach surgical drainage of subperiosteal orbital

abscess. By external approach a modified Lynch-

Howarth incision was made.




Medial wall of orbit and floor of right frontal sinus
Correspondence
was found to be dehiscent. Pus was drained out and
Dr. Ajay Lavania,
diseased mucosa of Frontoethmoid complex
Lecturer, Department of ENT
Manipal Teaching Hospital
removed. Endoscopically bilateral middle meatal
Email: ajayent1@rediffmail.com

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In 1937 Hubert classified the orbital complications of
Reference
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1. Maloney, J.R Badham , Mc Rae.A.(1987) –
1. Inflammatory edema of the eye lids with or
The acute orbit, preseptal (Periorbital)
without edema of orbital contents.
cellulitis, subperiosteal abscess and orbital
2. Sub periosteal abscess
cellulitis- Journal of Laryngology Otology -
3. Abscess of orbital tissues
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4. Mild to severe orbital cellulitis with
2. Hawkins D.B, Clark R.W (1977) Orbital
phlebitis of ophthalmic vein.
involvement in acute sinusitis. Lessons from
5. Cavernous sinus thrombosis.
24 Childhood patients -Clinical Paediatrics
6. With exception of preseptal cellulitis all
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other forms of acute cellulitis are associated
3. Chandler.J.R, Langenbrunner.D.J ,
with significant pain tenderness and
Stevens.E.R (1970). The pathogenesis of
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Orbital complications in acute sinusitis-

Laryngoscope 80, 1414-1428
Long term sequelae of orbital cellulitis
4. Gamble R.C (1933), Acute inflammation of
In addition to permanent visual loss and
the orbit in children. Archives of
ophthalmoplegia, cornea may become anaesthetic or
Ophthalmology 10, 483-497.
permanently damaged due to exposure keratitis6.
5. Hynes R.E. and Cramblett H.G (1967) Acute
Rupture of globe and iris prolapse have also been
ethmoiditis: Its relationship to orbital cellulitis,
described due to increased intra orbital pressure.
American Journal of Diseases of Childhood

114; 261-267.
Conclusion
6. Duke – Elder. S., MC FauL P.A (1974),
Orbital cellulitis is potentially a dreaded complication
System of Ophthalmology ;Vol 13 London
of sinusitis. In pre antibiotic era 17-20% of patients
:Kimpton, 859-889.
with orbital cellulitis died of meningitis or had
7. Forstot S.L and Ellis P.P (1979) Non traumatic
permanent visual loss. With the use of broad
rupture of the globe secondary to orbital
spectrum antibiotics and timely surgical intervention,
cellulitis- American Journal of Ophthalmology
morbidity and mortality has reduced drastically. This
- 88; 262-264.
case is reported as early detection and treatment can
prevent this dreaded complication of the sinusitis.

















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