Orbital cellulitis symptoms. Preseptal cellulitis is a diffuse swelling of the eyelids. Description, symptoms, treatment. After opening, antiseptic treatment is prescribed

Phlegmon of the orbit of the eye (the second name is orbital cellulitis) is an inflammation purulent nature, which covers the orbital tissue. This disease is recognized as a serious problem in the field of ophthalmology. surgical direction. Characterized severe course and a host of symptoms. In addition to violations visual apparatus the patient feels general malaise which is expressed by nausea, subfebrile temperature and severe headache.

Phlegmon of the orbit refers to diseases with a low frequency of diagnosis. But its consequences can be dangerous not only for the organs of vision, but also for the life of the patient as a whole. Progression and distribution purulent inflammation can cause complications such as meningitis or cerebral thrombosis. Therefore, it is very important not to self-medicate, but to seek qualified medical help.

Inflammation of the orbit in the first approximation is associated purulent diseases eye apparatus, epidermis, teeth, paranasal sinuses, jaws. Often the precursors are injuries of the facial skeleton or infections that affect the body.

Can be distinguished the following reasons phlegmon:

purulent sinusitis, or ethmoiditis (provokes the disease in 70% of cases);
transfer purulent exudate from foci localized on the epidermis of the human face (furunculosis, barley, erysipelas);
entry of pathogenic microorganisms into the orbital area;
dacryocystitis with purulent formations;
phlegmon of the upper or lower eyelid;
infected injuries of the eye orbit;
systemic infections (typhoid, influenza, scarlet fever);
inflammatory processes in the cavity of the teeth or jaws (periodontal disease, osteomyelitis, caries).

Very often, the pathological process begins with thrombophlebitis of the smallest veins of the orbit. Further, small abscesses will form, which can merge with each other, forming large abscesses. Phlegmon different localization(including an abscess of the orbit) may be the result of the vital activity of streptococcus, coli or staphylococcus. In the area of the organs of vision, pathogens move through the facial veins.

Symptoms

Signs of phlegmon usually make themselves felt suddenly. The disease progresses very quickly and becomes acute stage(sometimes only 4-5 hours are enough for symptoms to appear).

The defeat of the orbital tissue proceeds in several successive stages. Each of them is characterized by certain symptoms:

Preseptal cellulitis. This is a significant inflammation of the eyelids and skin tissues, which are located in front of the eye relative to the orbit of the eye. At this stage, their painful swelling is observed. At the same time, the mobility eyeball does not change, vision is maintained at the same level.
Orbital cellulitis. The period of disease progression during which inflammatory process moves on fabric posterior region orbital fascia. The visual acuity of the patient gradually decreases, the mobility of the eyeball becomes limited.

In the absence of proper treatment, the disease passes into the stage of subperiosteal abscess. The distance between bone wall the orbit of the eye and the periosteum is filled with a purulent mass. Upper eyelid increases in size, exophthalmos develops, vision decreases. At this stage, there is a noticeable displacement of the eyeball to one side.

Phlegmon and cellulitis of the orbit are also accompanied by some common symptoms. They include elevated temperature body, headache different intensity, weakness, decreased body tone.

If the process of formation of a purulent substance occurs only in the orbit, then an abscess is formed, which can open spontaneously through the epidermis or conjunctiva.

There is a possibility of a reverse situation, when the pus does not come out on its own, but the process spreads to the sinuses and the meninges. Sepsis develops, which can cause serious complications and even lead to the death of the patient.

Diagnostics

Any diagnosis of the eye apparatus begins with a detailed collection and analysis of anamnestic information. The doctor will find out if there have been purulent processes affecting the maxillofacial zone. Then he will consider clinical picture, perform an examination of the organs of vision using an eyelid lifter and palpate the external tissues.

On the this moment optometrists and ophthalmologists can offer patients following methods diagnosis of phlegmon of the orbit:

Ophthalmoscopy, or examination eye day by using special device- ophthalmoscope. Allows you to consider any pathology inside the eye, assesses the condition of the optic nerve;
Visometry - checking the degree of visual acuity. Various tables are used;
Biomicroscopy. Used to clarify the diagnosis;
Ultrasound of the eyeball. Used to study physiology internal structure eyes;
X-ray examination of the eye socket and sinuses. Allows differentiation of phlegmon from other diseases (for example, periostitis). This method can detect the presence of a foreign body in the eye or injury to the eyeball;
Tonometry, or a technique for measuring a value intraocular pressure.

As laboratory research patients are prescribed a blood test (general) and seeding for sterility.

Symptoms of eye inflammation are similar to those of many other eye diseases. Therefore, diseases such as dacryocystitis should be ruled out before making a definitive diagnosis. acute course, periostitis of the orbital wall, phlegmon of the eyelid, sarcoma, Quincke's edema, hemorrhage of the retrobulbar type.

Treatment

Patients who are faced with phlegmon of the orbit need competent treatment and hospitalization. Untimely appeal in a medical facility may even pose a threat to the life of the patient. The primary goal of therapy is to eliminate inflammatory focus in the tissues of the organs of vision. For this purpose, the ophthalmologist prescribes antibiotics related to drugs a wide range actions.

In the case of phlegmon treatment, tetracycline, sulfanilamide and penicillin series. The introduction of drugs can be carried out in a vein, intramuscularly, retrobulbarno or parabulbarno.

The use of drugs is supplemented by trepanation of the orbital wall, puncture and drainage of the paranasal sinuses, and thorough washing of their cavity. If the disease has passed into the stage of formation of fluctuations, then surgical intervention- orbitotomy. After opening, a swab moistened with an antibiotic solution (for example, sodium sulfacyl at a concentration of 30%) is inserted into the canal. During the first 48 hours after the operation, the dressing should be performed 2-3 times a day. If volume purulent discharge decreases, you can replace the tampon once a day.

Together with antibiotic therapy, treatment with anti-inflammatory and analgesic drugs is carried out. The doctor will also prescribe therapy aimed at detoxifying the body.

An additional measure in the treatment of phlegmon of the orbit are installations eye drops antibacterial composition in the area of the conjunctival sac. After some time, they are replaced with special fortified solutions. If there is a possibility of partial opening of the eyelids, then it is recommended to lay ointments based on antibiotics. Medical treatment must be supplemented with physiotherapy (eg, UHF, UVI), which is indicated for all patients. The exception is later stages when there is a softening of phlegmon.

Prevention

As mentioned above, purulent processes in the organs of vision can lead to severe complications. To avoid such consequences will help the correct and timely prevention. Ophthalmologists recommend visiting at least 1-2 times a year. This is especially important for those patients who have suffered or are currently being treated for any chronic or infectious disease of the eyes, skin of the face.

If a foreign body has entered the eye or mechanical damage membranes, it is important to conduct antibiotic therapy in order to prevent complications of an infectious nature.

Prevention of phlegmon includes timely detection and thorough sanitation purulent formations in the cavity of the teeth, gums, on the skin or in the structure of the ENT organs.

Preseptal cellulitis is inflammation of the eyelids and surrounding skin anterior to the orbital fascia; orbital cellulitis is an inflammation of the tissues of the orbit behind the orbital fascia. They can be caused by exogenous infection (with trauma), infection that spreads from the paranasal sinuses or teeth, as well as metastatic spread from an infectious focus of any localization. Symptoms include eyelid pain, discoloration and swelling;

Orbital cellulitis also causes fever, malaise, exophthalmos, and impaired eye movement and vision. Diagnosis is based on history, examination findings, and neuroimaging. Treatment is with antibiotics and sometimes surgical drainage.

Preseptal and orbital cellulitis are two various diseases, which are characterized similar symptoms. Preseptal cellulitis usually begins anterior to the orbital fascia, orbital cellulitis usually begins behind the orbital fascia. Both are more common in children; preseptal cellulitis occurs more frequently than orbital cellulitis.

Etiology and pathophysiology

Preseptal cellulitis develops due to the spread of infection with local trauma in the face or eyelid, insect bites, infections of the upper respiratory tract, conjunctivitis or chalazion.

Orbital cellulitis is most often caused by spread of infection from the adjacent sinuses, especially from the ethmoid sinus (from 75 to 90%); less commonly, it is caused by infection following trauma (eg, insect or animal bite, penetrating eye injury) or spread of infection from the face.

Pathogens vary in etiology and age. The most common pathogen associated with sinus infection is Streptococcus pneumoniae, while Staphylococcus pyogenes predominates in infection after local trauma. There are now fewer cases of Haemophilus influenzae, type B, after vaccination. Fungi are rare pathogens, causing orbital cellulitis in diabetic and immunosuppressed patients. In children younger than 9 years, one aerobic pathogen is detected; patients older than 15 years usually have a mixed aerobic and anaerobic infection.

Because orbital cellulitis arises from adjacent areas of violent infection (sinusitis) separated by a thin wall of bone, orbital infection can be severe and severe. Subperiosteal fluid collections may develop, sometimes in in large numbers, which are called subperiosteal abscesses, but many are initially sterile.

Complications include loss of vision (3 to 11%) from ischemic retinopathy and optic neuropathy; eye movement disorders (ophthalmoplegia) caused by inflammation of the soft tissues; intracranial consequences of central spread of infection, including cavernous sinus thrombosis, meningitis, and cerebral abscess.

Symptoms and signs

Preseptal cellulitis presents with tension, swelling, and redness or discoloration of the eyelids (violet in the case of H. influenzae). Patients are sometimes unable to open their eyes, but visual acuity may remain normal.

Symptoms and signs of orbital cellulitis include swelling and redness of the eyelids and surrounding soft tissues, hyperemia and swelling of the conjunctiva, limited eye movement, pain on eye movement, decreased visual acuity, and exophthalmos caused by orbital edema. Symptoms of the primary infection are often present (eg, nasal discharge and bleeding from sinusitis, periodontal pain and swelling from an abscess). Suspicion of meningitis can be caused by fever, malaise and headache. All of these features may be absent in early period diseases.

If subperiosteal abscesses are large enough, they can cause swelling and redness of the eyelids, impaired eye movement, exophthalmos, and decreased visual function.

Diagnostics

The diagnosis is established clinically. An ophthalmologist is called in if preseptal or orbital cellulitis is suspected, as visual acuity needs to be monitored. Eyelid edema may require eyelid retractors to examine the eyeball, primary signs complicated infections can be difficult to detect. Preseptal and orbital cellulitis can be identified clinically. The diagnosis of preseptal cellulitis is likely if the eye is normal except for swelling of the eyelids, there is a local focus of infection in the skin, and there are no symptoms. systemic disease. If evidence is uncertain, examination is difficult (in young children), or there is nasal discharge (sinusitis), CT should be done to confirm orbital cellulitis and diagnose sinusitis. If thrombosis of cavernous sinusitis is suspected, an MRI should be performed.

The direction of exophthalmos may be a clue to the localization of the infection; for example, distribution from frontal sinus causes the eye to shift downward and outward, from the ethmoidal sinus - laterally and outward.

Blood cultures are often tested in patients with cellulitis (better before antibiotics are used), but a positive response is detected in less than 33% of patients. If meningitis is suspected, lumbar puncture. Other laboratory tests are of little value.

The differential diagnosis is with non-infectious inflammation after trauma, insect bites without cellulitis; foreign body, allergic reaction, tumor, or other inflammatory diseases (eg, dacryocystitis, dacryoadenitis, orbital inflammatory pseudotumor). Inflammatory diseases can usually be diagnosed by localization and external manifestations.

Treatment

Both forms of cellulitis are treated with antibiotics.

In patients with preseptal cellulitis, treatment should be directed against the causative agents of sinusitis. Contaminated wounds may have a gram-negative infection. For treatment, amoxicillin with clavulanic acid at a dose of 30 mg / kg every 8 hours (for children under 12 years old) or 500 mg 3 times a day or 875 mg 2 times a day (for adults) for 10 days for the treatment of patients on an outpatient basis; for patients treated in hospital, ampicillin or sulbactam 50 mg/kg IV every 6 hours (children) or 1.5 to 3.0 (adults) IV every 6 hours (maximum 8 g ampicillin per day) within 7 days. Ambulatory treatment is an option for patients in whom orbital cellulitis has been definitely ruled out, or in children with no evidence of systemic infection who have responsible parents or guardians.

Patients with orbital cellulitis should be hospitalized and treated with antibiotics at the dose needed to treat meningitis. II-III generation cephalosphorins are used, such as cefatoxime 50 mg/kg IV every 6 hours (for children under 12 years of age) or 1-2 g IV every 6 hours (for adults) for 14 days if cellulitis is present; imipenem, ceftriaxone, and piperacillin/tazobactam are other drugs of choice. If cellulitis is associated with trauma or a foreign body, antibiotics that are active against Gram-positive (vancomycin 1 g IV every 12 hours) and Gram-negative pathogens (eg, ertapenem 100 mg IV once daily) should be selected for 7 to 10 days or until clinical improvement.

Surgical treatment to decompress the orbit and open the infected sinuses is indicated if vision is impaired and a foreign body is suspected. CT reveals orbital or subperiosteal abscesses or orbital infection that does not respond to antibiotics.

On the part of the organ of vision: exposure keratopathy, increased intraocular pressure, occlusion central artery or retinal veins, endophthalmitis, and optic neuropathy.
Intracranial (meningitis, brain abscess and cavernous sinus thrombosis) are rare. The latter is extremely dangerous and should be suspected with bilateral symptoms, rapidly increasing exophthalmos, and congestion in the veins of the face, conjunctiva, and retina. Additional features: fast rising clinical symptoms prostration, severe headache, nausea and vomiting.
Subperiosteal abscess is most often localized on inner wall orbits. Represents serious problem, because can rapidly progress and spread into the cranial cavity.
Orbital abscess is rarely associated with orbital cellulitis and develops after trauma or surgery.

Prefascial cellulitis

Prefascial cellulitis - infection soft tissues anterior to the tarsoorbital fascia. It does not per se belong to orbital diseases, but is considered here because it must be differentiated from orbital cellulitis, a rarer and potentially more serious pathology. Sometimes, rapidly progressing, it turns into cellulitis of the orbit.

trauma to the skin, such as a scratch or insect bite. Usually the causative agents are Staph. aureus or strep. pyogenes;
spread of local infection (chalazion or dacryocystitis);
hematogenous transmission of infection from a distant infectious focus located in the upper respiratory tract or middle ear.

Symptoms: one-sidedness, soreness, redness of the periorbital tissues and swelling of the eyelid.

Unlike orbital cellulitis, there is no exophthalmos. Visual acuity, pupillary reactions and eye movements are not disturbed.

Treatment: oral co-amoxiclav 250 mg every 6 hours. In severe cases, it may be necessary intramuscular injection benzylpenicillin total 2.4-4.8 mg per A injection and oral flucloxation 250-500 mg every 6 hours

Cellulitis of the orbit (orbital cellulitis) is rare disease in which infection of the eye cavity occurs. Symptoms of orbital cellulitis include pain in the eye, blurred vision, swelling of the eyelids, and malaise.

The most common cause of the disease is the spread of infection from the sinuses. Diagnosis includes examination of the patient, computed tomography (CT) or magnetic resonance imaging (MRI).

First of all, cellulitis of the orbit occurs in children and occurs in acute form. Treatment is with antibiotics. With the development of complications, apply surgical methods treatment.

Symptoms

Symptoms and signs of orbital cellulitis include:

Pain in one eye;
visual impairment;
Displacement of the eye;
swelling of the eyelid;
General malaise.

The first signs of the disease are swelling and redness of the eye, pain occurs quite quickly and vision deteriorates. Due to swelling, the eye is displaced and it seems that it pops out of the orbit.

If your child has these symptoms, contact the clinic or eye hospital immediately.

The reasons

Bacteria can enter the eye socket from the sinuses, an abscess on the eyelid, or a foreign object in the eye. As a result, they become infected soft tissues eye sockets. Usually only one eye is affected.

Diagnostics

The doctor will take a number of tests, including a blood test, to determine the cause and agent of the infection. May need CT scan(CT) to detect a foreign object in the eye or inflammation of the sinuses.

Treatment

Because orbital cellulitis is acute and dangerous infectious disease may require hospitalization. To combat the causative agent of infection, a course of antibiotics is prescribed. Might need surgery abscess.

orbital cellulitis - emergency, requiring timely diagnosis and treatment. AT severe cases the infection can progress at lightning speed within a few hours and lead to the development of fatal complications.

Epidemiology and etiology:
Age: any.
Sex: equally common in men and women.
Etiology: most common cause- sinusitis; less commonly, the disease occurs due to skin and dental infections, orbital injuries and dacryocystitis.

Anamnesis. Progressive swelling of the tissues surrounding the eye, within 1-3 days. The disease may be preceded respiratory infection, sinusitis.

Appearance of orbital cellulitis. With orbital cellulitis, edema, chemosis, exophthalmos, limitation of mobility and pain during movements of the eyeball are observed. Symptoms progress within 24-48 hours. With the development of infection, visual acuity may decrease. Sometimes there is a fever; a blood test reveals leukocytosis. It is important to distinguish the symptoms of orbital cellulitis from preseptal cellulitis, in which only swelling and redness of the eyelids are observed.

Visualization. CT is not done to make the diagnosis, but is done to determine the source of the infection (eg, sinusitis, orbital abscess) and rule out others. pathological processes(eg, tumors of the orbit). If foreign bodies or an orbital abscess are found, additional surgical intervention may be required.

Special cases. To prevent the spread of infection that can lead to thrombosis of the cavernous sinus, it is necessary to prescribe treatment in a timely manner.

Differential diagnosis of orbital cellulitis:
Preseptal cellulitis.
Orbital pseudotumor.
Orbital abscess.
Phycomycosis.
Metastatic lesion of the orbit.

Laboratory research. In a blood test, the number of leukocytes may be within the normal range. The information content of blood cultures is discussed.

Treatment of orbital cellulite. Immediate intravenous administration broad-spectrum antibiotics, orbital imaging, and careful monitoring for the first 24-48 hours.

Forecast. Good, but sometimes complications (abscess, cavernous sinus thrombosis) are possible.