Ocular pathology for clinicians. 8. Orbital cellulitis

The management of sinogenic orbital complications

The place of conservative treatment in sinogenic orbital complications has not been fully explained in the literature. The question that remains unresolved is--at which stage of the disease is surgery indicated? A study was undertaken in 240 patients with sinogenic orbital complications, to determine this. The patients were divided into three groups according to the stage of the disease as determined clinically: Group 1 (52 patients) with early stage disease, as detected by cellulitis only; Group 2 (76 patients) with intermediate stage, as detected by periorbital cellulitis and proptosis, but with full range of eye movement and unaltered vision; Group 3 (122 patients) with late stage disease, as detected by periorbital cellulitis and gross proptosis, with limitation of eye movement and altered vision. Group 1 and Group 2 patients were treated conservatively, with intravenous antibiotics and antral lavage. Group 3 patients were treated with intravenous antibiotics and surgery. External frontoethmoidectomy was performed in 31 (bilateral in two), ethmoidectomy in 91 (bilateral in five), sphenoidectomy in 15 and bilateral antral washout in all (122 patients). There was 100 per cent success with conservative treatment in Group 1 patients, whilst in Group 2 there was 98.6 per cent failure. The 75 patients in whom conservative treatment failed were successfully treated with surgery: frontoethmoidectomy was performed in 66 and ethmoidectomy in nine. In Group 3 patients, 100 per cent success was achieved with intravenous antibiotics and surgery. Sinogenic orbital complications can be treated conservatively and surgically, depending on the stage of the disease on presentation. Conservative treatment is only suitable for early complications, i.e. patients with periorbital cellulitis only.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of sinusitis presenting with spheno-cavernous syndrome: discussion of the differential diagnosis

A 60 year old gentleman presented with a left spheno-cavernous syndrome resulting in impaired ocular motility, proptosis and visual loss in an otherwise clinically quiet eye. The history led to a clinical suspicion of posterior ethmoiditis, which was confirmed on C.T. scanning. Surgical drainage and antibiotic treatment resolved the symptoms, but visual impairment persisted. The differential diagnosis and management of spheno-cavernous syndrome is discussed in context with this atypical presentation of orbital cellulitis.

Diagnostic methods in orbital diseases

Development of diagnostic methods for orbital diseases have practically revolutionized the approach to the patient with orbital disease. These newer methods have helped the clinician to improve the accuracy of the clinical diagnosis prior to biopsy, to localize the area to be biopsied, and to prevent inappropriate surgery. These techniques have also allowed the pathologist to render more definitive diagnosis. These methods include ultrasound, computerized axial tomography, nuclear magnetic resonance imaging, fine-needle aspiration biopsy, histochemistry, immunohistochemistry and electron microscopy. The techniques are complementary, and use of each depends on the clinical situation. Some techniques require collaboration between the surgeon and pathologist to assure proper fixation and preparation of tissues.