- Periorbital cellultitis
- Subperiosteal abscess
- Orbital abscess
The major features of post-septal infection are proptosis, painful eye movements, and ophthalmoplegia. Any of these findings justifies urgent CT with a view to surgical drainage.
In a retrospective study of children attending an emergency department, 50% of abscesses did not have these findings - multivariate analysis showed that other major risk factors were:
- neutrophils >10
- absence of infectious conjunctivitis
- periorbital (ie beyond eyelid) oedema
These factors had ORs in the range 5.9-8.6. Age >3yrs and previous antibiotic therapy were also significant but less so (OR 2.3-3.6). Fever is often not seen!
From sinus cultures, mostly streptococcus (viridans, Group A, pneumococcus) and staphylococcus (mostly non-aureus!), often multiple, occasional haemophilus. Treatment with penicillin/cefuroxime and flucloxacillin should cover most, additional anaerobic cover may be required. Nasal congestants often used.
This article is a work in progress. Please feel free to contribute to it.
- ↑ a b Chandler JR, Langenbrunner DJ, Stevens ER. The pathogenesis of orbital complications in acute sinusitis. The Laryngoscope. 1970 Sep; 80(9):1414-28.(Link to article – subscription may be required.)
- ↑ Velasco e Cruz AA, Demarco RC, Valera FC, dos Santos AC, Anselmo-Lima WT, Marquezini RM. Orbital complications of acute rhinosinusitis: a new classification. Brazilian journal of otorhinolaryngology. 2007 Sep-Oct; 73(5):684-8.
- ↑ Rudloe TF, Harper MB, Prabhu SP, Rahbar R, Vanderveen D, Kimia AA. Acute periorbital infections: who needs emergent imaging? Pediatrics. 2010 Apr; 125(4):e719-26.(Link to article – subscription may be required.)