Orbital cellulitis: pathophysiology

Orbital cellulitis usually occurs as a result of:

Extension of an infection from the periorbital structures (usually the

paranasal sinuses, especially ethmoid sinusitis) and also from the
face, the globe, the lacrimal sac and dental infection (via an
intermediary maxillary sinusitis).
Occasionally, it may occur as an extension of preseptal cellulitis,
particularly in young children in whom the orbital septum is not fully
developed.[1]
Direct inoculation of the orbit from trauma (accidental or surgical -
including orbital, lacrimal, strabismus and vitreo-retinal surgery). Post-
traumatic orbital cellulitis tends to develop within 72 hours of the
injury.
Haematogenous spread from distant bacteraemia.
The pathogens most commonly involved are the aerobic, non-spore-forming bacteria
-Streptococcus pneumoniae, Staphylococcus aureus, Streptococcus
pyogenes andHaemophilus influenzae (the latter mainly found in children).[2]
Mucormycosis associated with patients who have diabetic ketoacidosis or
immunosuppression is also described.[3] This very rare and rapidly spreading
infection caused by fungi, is aggressive and often fatal. [4]
There has recently been an emergence of Meticillin-resistant S.
aureus (MRSA) in the organisms isolated; this is rare but the development is
worrying.[5] Orbital cellulitis may be complicated by spread to adjacent structures
and to the central nervous system.

Orbital cellulitis:
Sudden onset of unilateral swelling of conjunctiva and lids.
Proptosis (bulging of the eye).
Pain with movement of the eye, restriction of eye movements.
Blurred vision, reduced visual acuity, diplopia.
Pupil reactions may be abnormal - relative afferent pupillary defect
(RAPD); see the separate article on Examination of the Eye.
Fever, severe malaise.

Investigations
Diagnosis is usually made based on the clinical findings and
investigations are aimed at identifying the root cause of the infection -
particularly in the case of orbital cellulitis. Investigations are carried
out in the hospital setting.
 FBC frequently shows a leukocytosis (>15 X109) but blood
cultures are frequently negative in adults. They cannot be counted on
to differentiate between preseptal and orbital cellulitis.
Any discharge from skin breaks should be swabbed and sent to
microbiology. Throat swabs and samples of nasal secretions may also
help diagnosis.
CT of the sinuses as well as the orbit brain:
CT is usually indicated only for children (unless the child is
very well and the episode is mild) or if orbital cellulitis is
suspected in an adult.
if an intracranial abscess is suspected, CT is the gold standard
imaging modality, carried out to identify any subperiosteal
abscesses, paranasal sinusitis or cavernous sinus thrombosis (all
needing multi-speciality input).
It is also valuable in assessing trauma where there may be
concerns about a retained orbital or intraocular foreign body.
MRI may complement the CT in diagnosing a cavernous sinus
thrombosis.
If cerebral or meningeal signs develop, the patient may need a
lumbar puncture. However a lumbar puncture is contra-indicated for
suspected orbital cellulitis until a CT scan has ruled out raised
intracranial pressure.[11]

Orbital cellulitis

Hospital admission under the joint care of the ophthalmologists and
the ENT surgeons is mandatory.[2]

Intravenous antibiotics are used (eg, cefotaxime and flucloxacillin) in
addition to metronidazole in patients over 10 years old with chronic
sinonasal disease.[3]

Clindamycin plus a quinolone such as ciprofloxacin are used where
there is penicillin sensitivity. Vancomycin is also an alternative.

Optic nerve function is monitored every four hours (pupillary
reactions, visual acuity, colour vision and light brightness
appreciation).

Treatment may be modified according to microbiology results and
lasts for 7-10 days.

Surgery is indicated where there is CT evidence of an orbital
collection, where there is no response to antibiotic treatment, where
visual acuity decreases and where there is an atypical picture which
may warrant a diagnostic biopsy. Surgery often concurrently warrants
drainage of infected sinuses.[4]
Complication

Orbital cellulitis[4]
Ocular: exposure keratopathy (which can lead to visual loss through
permanent damage to the cornea), raised intraocular pressure, central
retinal artery or vein occlusion, endophthalmitis, optic neuropathy.
Orbital abscess: more often associated with post-traumatic orbital
cellulitis. Blindness can occur through direct extension of the infection
to the optic nerve.
Subperiosteal abscess: usually located along the medial orbital
wall. This may progress intracranially.
Intracranial (rare): meningitis, brain abscess, cavernous sinus
thrombosis.

Prognosis

Orbital cellulitis
Early recognition and appropriate treatment should carry a good prognosis,
particularly in the absence of complications. However immunosuppressed individuals
are more susceptible to complications and fungal cellulitis can be associated with a
high rate of mortality.

Orbital Cellulitis

What is it?
Orbital cellulitis is a bacterial infection of the periocular tissues. Cellulitis
restricted to the soft tissues anterior to the orbital septum (a connective
tissue curtain that divides the anterior third from the posterior two thirds
of the orbit) is called "pre-septal cellulitis." It is much less serious than
infection that extends behind the orbital septum, called "post-septal
cellulitis."
 The infection usually starts in the paranasal sinuses, especially the
ethmoid. It is especially common in children.

Orbital cellulitis is rare in adults, except among the immunocompromised

diabetes mellitus, chronic immunosuppressive agents, or irradiation. In
these patients, the big danger is fungal infectionmucormycosis or
aspergillosis. Both are life-threatening fungal infections that require
prompt management.

How does it present?

Orbital cellulitis presents with periocular pain, violaceous swelling of upper
and lower lids, and mild, diffuse conjunctival hyperemia. Fever and upper
respiratory infection symptoms may be present in children. The eyelids
and globe are tender to the touch. If the infection extends posterior to the
orbital septum, there will be reduced ocular movement and proptosis.
Visual loss is rare.

In adults, fungal orbital infection originates more posteriorly in the orbit

and may show minimal swelling. Ptosis, reduced eye movement, and
vision loss are more common.

Delayed treatment can lead to blindness and intracranial spread of

infection with meningitis, stroke, and death.

What to do?
Order sino-orbital imaging studies to rule out sinusitis, orbital
subperiosteal abscess, or tumor. Treat with intravenous
antibiotics. Subperiosteal abscess may require surgical drainage.

Lack of improvement in 24 to 48 hours signals either an incorrect

diagnosis or ineffective antibacterial agents.

Always think of fungal infections in immunocompromised hosts!

Orbital cellulitis is an acute infection of the tissues immediately surrounding the eye,
including the eyelids, eyebrow, and cheek.

NEWS & FEATURES

For a Teenage Boy, a Basketball and a Bug Spell Trouble
REFERENCE FROM A.D.A.M.
Back to TopCauses
Orbital cellulitis is a dangerous infection with potentially serious complications.
Bacteria from a sinus infection (often Haemophilus influenzae)usually cause this
condition in children. Orbital cellulitis due to this bacteria used to be much more
 common in young children up to age 6 - 7. However, such infection is now rare
because of the HiB (Haemophilus influenzae B) vaccine.
The bacteria Staphylococcus aureus , Streptococcus pneumoniae , and beta-
hemolytic streptococci may also cause orbital cellulitis.
Orbital cellulitis infections in children may get worse very quickly and can lead to
blindness. Immediate medical attention is needed.
Back to TopSymptoms
Symptoms of orbital cellulitis may include:
Painful swelling of upper and lower eyelid, and possibly the eyebrow and
cheek
Bulging eyes
Decreased vision
Eye pain, especially when moving the eye
Fever, generally 102 degrees F or higher
General ill feeling
Painful or difficult eye movements
Shiny, red or purple eyelid
Back to TopExams and Tests
Tests commonly include:
CBC (complete blood count)
Blood culture
Spinal tap in extremely sick children
Other tests may include:
X-ray of the sinuses and surrounding area
CT scan or MRI of the sinuses and orbit
Culture of eye and nose drainage
Throat culture
Back to TopTreatment
The patient usually needs to stay in the hospital. Treatment includes antibiotics given
through a vein. Surgery may be needed to drain the abscess, or relieve pressure in the
orbital space around and behind the eye.
An orbital cellulitis infection can get worse very quickly. The patient must be
carefully checked every few hours.
Back to TopOutlook (Prognosis)
With prompt treatment, the person can make a complete recovery.
Back to TopPossible Complications
Cavernous sinus thrombosis
 Hearing loss
Septicemia or blood infection
Meningitis
Optic nerve damage and loss of vision
Back to TopWhen to Contact a Medical Professional
Orbital cellulitis is an emergency that requires immediate treatment. Call your health
care provider if there are signs of eyelid swelling, especially with a fever.
Back to TopPrevention
Receiving the HiB vaccine according to recommended schedules generally will
prevent most haemophilus infections in children. Young children in the same
household who have been exposed to this bacteria may receive antibiotics to prevent
getting sick.
Proper detection and early treatment of sinus, dental, or other infections may
prevent the spread of infection to the eyes.

INTRODUCTION

Orbital cellulitis is a relatively uncommon infective process involving ocular adnexal

structures posterior to the orbital septum.1 Inflammation anterior to the orbital
septum or preseptal cellulitis is common in young children. It rarely involves
postseptal anatomy, and physical examination reveals eyelid edema in the absence of
orbital signs such as gaze restriction and proptosis.2 Orbital cellulitis is a condition
that rarely causes complete loss of vision if treated in a timely fashion. A history of
upper respiratory tract infection prior to the onset is very common especially in
children. For simplification, Chandler et al.3has classified the disease into five
categories and emphasized the possibility of fatality due to cavernous sinus
thrombosis and intracranial abscess. Despite advances in antimicrobial therapy and
surgical methods, intracranial abscess remains a challenging problem and the
mortality rate can be as high as 40%.4 In the past, orbital cellulitis has been
associated with a number of serious complications including loss of visual acuity,
cavernous sinus thrombosis, meningitis, frontal abscess and osteomyelitis, and even
death.1,5 Since the advent of effective antibiotic treatment, these serious
complications have become much less frequent. Prior to the availability of
antibiotics, blindness was a relatively common complication of orbital cellulitis,
reported in approximately 20% of cases.6 Case reports of blindness following
bacterial orbital cellulitis in the postantibiotic era are rare. For example, Connel et
al.,7reported a case of a 69-year-old male who presented with fulminant onset of
proptosis, significant ophthalmoplegia and no light perception. Despite emergent
drainage of an orbital abscess and aggressive intravenous antibiotic therapy, there
was no improvement in vision; although ocular motility returned to normal. 7 The
mechanism of vision loss in Connel et al.7 case remained unknown. The authors
postulated streptococcal-related ischemic necrosis of the posterior aspect of the optic
nerve as a possible mechanism of vision loss. In a recent survey of 52 patients with
orbital cellulitis, 18 (35%) presented with decreased visual acuity; however, with
long-term follow-up, only two (4%) patients had decreased vision.5

PREDISPOSING FACTORS

The most common predisposing factor for orbital cellulitis is sinus disease,
particularly in the younger age groups.1,5 The infection most commonly originates
from sinuses [Figure 2], eyelids, face, dental abscess, retained foreign bodies, or
distant soources by hematogenous spread.1,5,911 Chandler et al.3has grouped
complications of sinusitis into five classes. In group 1, the eyelids are swollen with
the presence of orbital content edema (preseptal cellulitis). The swelling reflects an
impedance to drainage through ethmoid vessels. Venous congestion is transmitted
through the valveless veins to the eyelids and through the superior ophthalmic vein
to the orbit. In group II (orbital cellulitis), there is a diffuse infiltration of orbital
tissues with inflammatory cells. The eyelids may be swollen and there may be
conjunctival chemosis with variable degree of proptosis and visual loss. In group III
(subperiosteal abscess), purulent material collects periorbitally and in the bony walls
of the orbit. There is pronounced eyelid edema, conjunctival chemosis, and
tenderness along the affected orbital rim with variable degree of motility, proptosis,
and visual acuity changes depending on the size and location of the abscess. In group
IV (orbital abscess), there is a collection of pus inside or outside the muscle cone due
to progressive and untreated orbital cellulitis. Proptosis, conjunctival chemosis,
decreased ocular motility, and visual loss may be severe in these cases. In group V
(cavernous sinus thrombosis), there is an extension of orbital infection into the
cavernous sinus that can lead to bilateral marked eyelid edema and involvement of
the third, fifth, and sixth cranial nerves. There may be associated generalized sepsis,
nausea, vomiting, and signs of altered mentation. An orbital apex syndrome,
characterized by proptosis, eyelid edema, optic neuritis, ophthalmoplegia, and
neuralgia of the ophthalmic division of the fifth cranial nerve is caused by sinus
disease around the optic foramen and superior orbital fissure
The outcomes from one of the largest series of orbital cellulitis from a developing
country confirms previous observations from Western countries in which sinus
infection has been implicated as the cause of orbital cellulitis in most of the reported
cases.1 Specifically in the pediatric population, up to 90% of patients with orbital
cellulitis had existing sinusitis, with almost half having multiple sinus involvement.
Unlike patients in Western countries, most patients with sinusitis and orbital
cellulitis sought treatment later in the course of their disease in this study. After
sinusitis, periocular trauma and history of ocular or periocular surgery were the
cause of a significant number of cases of orbital cellulitis among these patients,
compared with the studies of orbital cellulitis from Western countries. 5,8 Less
commonly reported causes of orbital cellulitis, such as dacryocystitis, dental
infection, and endophthalmitis also were found among these patients [Figure 3].
Sinusitis may also produce osteomyelitis and intracranial abscess. Osteomyelitis,
commonly involving the frontal bone, is a direct extension of frontal infection or
septic thrombophlebitis via the valveless sinus of Breschet. 13 Osteomyelitis is rare in
the ethmoids because from this location, infection can rapidly spread through the
thin lamina papyracea into the orbit or maxilla, where arterial anastomoses are
sufficient to prevent necrosis due to septic thrombosis of a single artery. Although
meningitis is the most common intracranial complication of sinus disease, epidural,
subdural, and brain parenchymal abscess can also occur.13

INVESTIGATIONS

Although ultrasonography (U/S) can be useful as an in-office screening procedure in

cases of suspected orbital abscesses, CT-scan is necessary to assess the sinuses and
intracranial extension. On orbital U/S, orbital abscess may show low internal
reflectivity. On CT-scan, one may see a localized, generally homogenous elevation of
the periorbita adjacent to an opacified sinus. Imaging studies may show evidence of
inflammatory or infective changes in the orbital structures. In the pediatric group,
more patients may have subperiosteal abscess as compared to the adult group at the
time of initial presentation. For example, in the series reported by Ferguson and
McNab,5 among children, 29% had inflammatory change only, 62% had a
subperiosteal abscess, while only 9% had orbital abscesses, compared with 72%, 5%,
and 22%, respectively, in the adult group. In addition to its essential role in the
diagnosis of orbital abscess, CT-scan may also influence the initial therapeutic plan
by demonstrating the size and location of the abscess and the specific sinuses
involved, factors that may be considered if surgical drainage is
considered.1,16 However, CT-scan characteristics of subperiosteal collection may not
be predictive of the clinical course. For example, the findings in patients who
recovered with antibiotic therapy alone were similar to the findings in patients who
underwent surgical drainage.17 It has been shown that the size of an orbital abscess
on imaging studies may increase during the first few days of intravenous antibiotics
regardless of the bacteriologic response to the treatment. 17 The identification of
orbital abcess is a diagnostic challenge. The reliability of CT-scan in demonstrating
orbital abcess has been questioned. In a series of 25 cases of orbital infection, all 15
orbital abscesses were satisfactorily demonstrated provided the CT examination
included coronal sections.28 According to this study, one-third of abscesses would
have been missed if coronal sections had been omitted. Magnetic resonance imaging
(MRI) may be necessary in some cases where CT-scan have not satisfactorily
addressed clinician's concerns with other imaging techniques.

The development of an orbital abscess does not correlate specifically with visual
acuity, proptosis, chemosis, or any other sign.13 Therefore, diagnostic procedures are
essential in evaluating the patient with orbital cellulitis for possible abscess or
retained orbital foreign body. Sinus x-ray can demonstrate an air-fluid level, if
present, in an abscess cavity; however, gas-free abscesses may not be readily
visible.13 Ultrasound can detect an abscess of the anterior orbit or medial wall with
90% efficiency,20although an acute abscess may be poorly delineated. The
investigative procedure of choice to diagnose orbital infection is the CT-
scan.1,29 Orbital walls, extraocular muscles, optic nerve, intraconal area, and adipose
tissue can be clearly seen. An orbital abscess is visualized as a homogenous, a ring-
like, or a heterogeneous mass and the site of origin, orbital or subperiosteal, and
extent of abscess are readily visible.1,17 Contrast-media can enhance the surrounding
wall of an abscess. CT-scan does not differentiate between preseptal cellulitis and
eyelid edema but will differentiate between preseptal and orbital cellulitis. 13 Sinus
disease and intracranial complications will also be evident on CT-scan, as will most
foreign bodies. Thus, CT-scan is the most comprehensive source of information on
orbital infections and the most sensitive means of monitoring the resolution of
orbital or intracranial lesions. CT-scan is indicated in all patients with periorbital
inflammation in whom proptosis, ophthalmoplegia, or a decrease in visual acuity
develops, also in cases where a foreign body or an abscess is suspected, in cases
where severe eyelid edema prevents an adequate examination, or in whom surgery is
contemplated.1,13,16,17,29

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BACTERIOLOGY OF ORBITAL ABSCESSES

Commonly reported bacteria from the abscesses of the orbit include Staphylococcus
aureus, Staphylococcus epidermidis, Streptococci, Diphtheroids, Haemophilus
influenza, Escherichia coli and multiple species including aerobes and anaerobes. No
growth in up to 25% of abscesses.13 The results of microbiological investigation by
Ferguson and McNab5 varied with differences in the rate of testing between the
pediatric age group and the older age group. Some form of culture was performed in
93% of their patients.5 Among 50% of patients, who had blood cultures performed,
none yielded positive results.5 In their5 study, cultures taken from abscesses were
more likely to produce positive results. There was no correlation between
conjunctival swab cultures and the etiological organism recovered from the abscesses
of patients with positive cultures.5 S. aureus was the most common pathogen.5 In the
pediatric group various species
of Streptococcus predominated.5 Anaerobic Streptococcus was isolated in four
pediatric patients, two cases with mixed anaerobes and one with Clostridium
bifermentans.5 Anaerobic orbital cellulitis was much less common in adults, with
only one case of mixed anaerobes. Multiple organisms were isolated in only five
adults and four pediatric patients. No pathogens were isolated from six adults and 15
pediatric patient by Ferguson and McNab.5 In the past,H. influenza was a major
pathogen responsible for orbital cellulitis in the pediatric age group. 1,13 In the series
reported by Ferguson and McNab,5 no cases of H. influenza were detected in the
pediatric age group and only one case was found in an adult patient. The
authors5 attributed this observation due to the general immunization of children
with H. influenza type B vaccine since the early 1990s.

The bacteriology of orbital abscesses has received little attention. In a study of

cultures of the contents of the abscess cavity, a wide range of organisms including S.
aureus, S. epidermidis and Streptococci, H. influenza, E. coli, and diptheroids have
been reported. The role of anaerobes, not usually considered pathogens in sinus
disease, is unclear. However, a considerable number of cultures in adults have
yielded anaerobes.1,16,18 Patients in the first decade of life generally have infections
caused by single aerobic pathogens which are usually responsive to medical therapy
alone. Patients older than 15 years of age have complex infections caused by multiple
aerobic and anaerobic organisms that are slow to clear despite medical and surgical
intervention.18 The complexity of pathogens and responsiveness to antimicrobial
therapy appear to be age related.16,30 As the size of the sinus cavities enlarge, the ostia
appear to narrow with increasing age creating optimal conditions for anaerobic
bacterial growth. With increasing age, there is a trend toward more complex
infections. In mixed infections, aerobes consume oxygen which encourages anaerobic
microbial growth. Additionally, anaerobes produce B-lactamase that renders
antibiotics ineffective. Harris,16 reviewed the microbiology results of 37 of his
patients with orbital abscesses. Twelve patients were younger than 9 years. Of these,
58% were culture negative and the rest had a single aerobic pathogen. Sixteen
patients between ages 914 years showed a transition toward more complex
infections.16 Nine patients older than 15 years, were all culture positive after more
than 3 days of antibiotic therapy. From the older group, polymicrobial infections
were recovered more often and anaerobes were found in all cases.16
From their vast experience with orbital abscesses, Harris and Garcia, 18 concluded
that surgical therapy for orbital abscesses should be influenced by several factors,
including the visual status, the size and location of the orbital abscess, intracranial
complications, the sinuses involved, the presumed pathogens, and the anticipated
bacterial response to antibiotic treatment. Harris and Garcia recommended
emergency drainage of the orbital abscesses and sinuses of patients of any age whose
optic nerve or retinal function is compromised. Urgent drainage was also
recommended for large abscesses or extensive superior or inferior abscesses that
might not resolve quickly, even if sinusitis is medically cleared. Urgent drainage was
also recommended for intracranial complications at the time of presentation and in
frontal sinusitis, in which the risk of intracranial extension is increased, and when
complex infections that include anaerobesare suspected. An expectant approach has
been recommended for patients younger than 9 years of age in whom simple
infections are suspected. Surgery may be warranted if: there is no clinical
improvement in a timely manner; relative afferent pupillary defect develops at any
time; fever does not abate within 36 h, suggesting that the bacteremia is not
responding to the choice of antibiotics; if there has been deterioration despite 48 h of
appropriate antibiotic therapy or no improvement despite 72 h of treatment.
Improvement of CT findings should be expected to lag behind the clinical picture. In
fact, the CT findings may seem worse during the first few days of hospitalization
despite successful treatment with antibiotics alone.17

Microbes can cause necrotizing lid disease that is often referred as necrotizing
fascitis.7,3133 This may progress to systemic manifestation including potentially fatal
toxic streptococcus syndrome, characterized by multiorgan failure. 31,33 These
complications can occur in the absence of antecedent health problems or history of
trauma.7,32,33 The virulence of this organism is related to the production of M proteins
and exotoxins A and B.34 These proteins act as super-antigens in vitro and mediate
tissue necrosis by causing massive release of cytokines such as tumor necrosis factors
and interleukins.

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TREATMENT

Intravenous antibiotics are usually started once the diagnosis of orbital cellulitis is
suspected. Broad-spectrum antibiotics that cover most gram positive and gram
negative bacteria should be selected. Antibiotic recommendations are based on the
microorganisms most frequently recovered from abscesses; S. aureus, S.
epidermidis, Streptococci, and Haemophilus species.13 Mixed infections including
aerobic and anaerobic species may be found.16 Cultures from the conjunctiva, nose
and throat are usually not representative of the pathogens cultured from the
abscesses and blood cultures may be frequently negative. 13 In many studies, a
combination of a third-generation cephalosporin and flucloxacillin is used. 1,5 Most
patients receive oral antibiotics on discharge for varying periods of time. For
example, all patients in the Ferguson and McNab5 study received intravenous
antibiotic treatment and most of their patients had received multidrug therapy with
up to five different antibiotics. In all cases treatment regimens were empirically
based and instituted prior to identification of the pathogens.5

Patient age has been identified as a factor in the bacteriology and response to
treatment of orbital abscess. In general, children less than 9 years of age have been
found to have simpler, more responsive infections, primarily involving a single
aerobic pathogen. Older children and adults may have more complex infections
caused by multiple aerobic and anaerobic organisms, refractory to both medical and
surgical treatment.16 In addition to starting intravenous antibiotics, emergent
drainage of the orbital abscesses has been suggested in patients with compromised
vision regardless of age. Urgent drainage (within 24 h of presentation) has been
recommended for large abscesses, for extensive superior or inferior orbital abscesses,
for patients with intracranial complications, for infections of known dental origin in
which anaerobes might be expected.16 An individualized therapeutic approach
requires a clinician to carefully follow these children and to exercise surgical option if
improvement does not occur in a timely fashion. Careful monitoring of the clinical
course is mandatory and comparison of serial CT-scan may be necessary as an
adjunct to clinical judgment. In a previous study by Harris, 16 children younger than 9
years old recovered with antibiotic treatment alone with successful clinical outcomes.
Harris16 describes a sliding scale of risk associated with increasing age and argues
that patients in the older age group who present with orbital cellulitis should
undergo prompt sinus surgery, even before orbital or intracranial abscesses develop.
Once sinus infection in older children or adults has extended in the orbit as an
abscess, urgent drainage should include the orbit and all infected sinuses. 16 CT-scan
may not be accurate in assessing clinical course in some of these patients. In a review
of 37 cases of orbital abscesses, Harris16, found that subperiosteal material could not
be predicted from the size or relative radiodensity of the collections in CT
scans.17 Initial scans were not predictive of the clinical course. Serial scans showed
enlargement of abscesses during the first few days of intravenous antibiotic therapy,
regardless of the ultimate response to treatment. Harris, concluded that expansion of
orbital abscess in serial CT scans during the first few days of treatment should not be
equated to failure of the infection to respond to antibiotics alone.17

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SURGICAL INTERVENTION

Surgical treatment is indicated for significant underlying sinus disease, orbital or

subperiosteal abscess or both in the pediatric age group. In adults, sinus surgery
remains the most common surgical intervention. The argument remains between
early drainage of orbital abscess to prevent complications versus the possibility of
seeding the infection through early surgery.16 Harris has outlived a useful approach
in the management of an orbital abscess.16 He recommends emergency drainage for
patients of any age, whose visual function is compromised. Urgent drainage, usually
within 24 h, is indicated for the following: large orbital abscess causing discomfort,
superior or inferior orbital abscess, evidence of intracranial extension, involvement
of frontal sinuses, and a known dental source of the infection in patients older than 9
years [Figure 4].16 An expectant approach is indicated for patients younger than 9
years with medial subperiosteal abscess of modest size, no visual loss and no
intracranial or frontal sinus involvement. Careful evaluation and close monitoring of
the optic nerve function and the level of consciousness and mental state of the
patient is very important. An incision down to the periosteum at the inner quadrant
of the orbit may be made to drain the subperiosteal abscess. A drain may be inserted
and tissues may not need to be sutured, but left to granulate. The drain may be left in
place for 78 days. Functional endoscopic sinus surgery (FESS) has been shown to
be effective for the treatment subperiosteal abscess due to complication of paranasal
sinusitis. The advantage of FESS is the avoidance of external ethmoidectomy and
associated external facial scar and an early drainage of the affected sinuses and
subperosteal abcess.35

MECHANISM OF VISUAL LOSS IN ORBITAL CELLULITIS

Permanent loss of vision has been noted as a complication of orbital infection since
1893 and blindness was reported in up to 20% of patients with postseptal
inflammation in the preantibiotics era.6 However, permanent loss of vision resulting
from orbital inflammation is unusual in this era of antibiotics.20,21In a previous study,
4 of 38 patients with postseptal disease had permanent loss of vision with one of
these patients progressing to no light perception.21 The mechanism for loss of vision
with orbital inflammation may involve: (1) optic neuritis as a reaction to adjacent or
nearby infection; (2) ischemia resulting from thrombophlebitis along the valveless
orbital veins or; (3) compressive/pressure ischemia possibly resulting in central
artery occlusion.6,21 Because clinical examination by itself may not exactly delineate
the nature of postseptal inflammatory processes, clinicians may have to rely on
imaging studies to select potential surgical candidates. Despite modern imaging
techniques, the clinician must rely on the clinical progression of the inflammation
based on visual acuity testing, pupillary reactivity, and ocular motility assessment.
Patt and Manning,21 reported four cases of permanent blindness as a result of
postseptal orbital inflammation. In each case, CT-scan readings of no definite
abscess contributed to delay in diagnosis of orbital abscess, with a resultant delay in
surgical drainage.

The ethmoidal sinuses are separated from the orbital contents by the lamina
papyracea and anterior and posterior ethmoidal foramina serve as additional
connections that may allow infection to gain access from ethmoidal air cells to the
orbital contents. The periorbita in this area is loosely attached to bone and may be
elevated by a purulent collection, resulting in subperiosteal abscess. Severe
irreversible visual loss may occur in cases with orbital and subperiosteal abscess. In a
survey of 46 cases with a confirmed diagnosis of orbital and subperiosteal abscess in
which visual results were reported, permanent blindness developed in seven (15%)
cases.36 In four cases, blindness was attributed to central retinal artery occlusion, in
two cases optic atrophy occurred, and in one case no details were provided.
Irreversible visual loss in orbital cellulitis probably has a vascular cause, whereas
cases with reversible visual loss that respond to antibiotic therapy and drainage
procedures most likely are due to infiltrative or compressive optic neuropathy. The
confinement of the optic nerve in the orbital apex and within the bony canal and its
proximity to the posterior ethmoid and sphenoid sinuses magnify the importance of
the casual factors in posterior orbital cellulitis. Clinicians should be aware that
patients with sinusitis and associated orbital cellulitis are at risk for developing
severe visual loss and should be treated promptly. Hornblass 13 reviewed 148 patients
from 13 series reporting orbital abscess and found three cases of no light perception
vision.

Acute visual loss may be associated with acute sinusitis either secondary to
complicated orbital cellulitis or as a part of the orbital apex syndrome. 37 El-Sayed and
Muhaimeid,37 reported two cases of acute visual loss as a complication of orbital
cellulitis due to sinusitis. In one patient dramatic improvement in vision from hand
motion to normal vision resulted after intravenous treatment of pansinusitis and
associated orbital cellulitis.37 A second patient (a 10-year-old female) recovered
vision from no light perception to normal levels after exploration of the sphenoid and
ethmoid sinuses along-with intravenous antibiotics. Slavin and Glaser, 36,37 described
three cases of sphenoethmoiditis causing irreversible visual loss associated with
minimal signs of orbital inflammation and renamed the entity posterior orbital
cellulitis. Slavin and Glaser36,37 defined it as a clinical syndrome in which early
severe visual loss overshadows or precedes accompanying inflammatory orbital
signs. Acute blindness may also result from orbital infarction syndrome. Orbital
infarction is a disorder that may occur secondary to different mechanisms such as: (i)
acute perfusion failure, that is, common carotid artery occlusion; (ii) systemic
vasculitis, that is, giant-cell arteritis; (iii) orbital cellulitis with vasculitis, that is,
mucurmycosis. The blindness and retinal and optic nerve damage can be
permanent.38 In developing countries, most patients with sinusitis and orbital
abscess tend to present late in the course of the disease. Most patients with refractory
or complicated subperiosteal abscesses are older children or adults. For example, in
one of the largest studies reported, four patients were permanently blind out of 159
patients with orbital complications of sinusitis.21 All four had surgically confirmed
subperiosteal abscess, and all were 15 years of age or older. In another study, among
the 13 patients with intracranial abscess that resulted from sinusitis or orbital
abscesses, two patients were 9 to 14 years of age and 11 were 15 years of age or older. 4

Penyebab Dan Gejala Selulitis Orbitalis

selulitis orbitalis

Penyebab Selulitis Orbitalis

Penyebab terjadinya selulitis orbitalis adalah infeksi bakteri. Infeksi bisa berasal dari
sinus, gigi atau aliran darah, atau bisa terjadi setelah suatu cedera mata. Pada anak-
anak, selulitis orbitalis biasanya berasal dari infeksi sinus yang disebabkan oleh
Hemophilus influenzae. Bakteri lainnya yang bisa menyebabkan selulitis orbitalis
adalah Staphylococcus aureus, Streptococcus pneumoniae dan streptokokus beta
hemolitikus yang menyerang tubuh penderita.

Kondisi predisposisi untuk selulitis termasuk gigitan serangga, melepuh, gigitan

hewan, tato, ruam gatal kulit, operasi terakhir, athletes foot, kulit kering, eksim, obat
suntikan (terutama subkutan atau injeksi intramuskular atau mana injeksi IV
berusaha merindukan atau pukulan vena), kehamilan, diabetes dan obesitas, yang
dapat mempengaruhi sirkulasi, serta luka bakar dan bisul, meskipun ada perdebatan
mengenai apakah lesi kaki kecil berkontribusi.

Selulitis disebabkan oleh jenis bakteri memasuki kulit, biasanya dengan cara
dipotong, abrasi, atau istirahat di kulit. Istirahat ini tidak perlu terlihat. Streptococcus
Grup Adanaureus adalah yang paling umum dari bakteri ini, yang merupakan
bagian dari flora normal kulit tetapi tidak menyebabkan infeksi yang sebenarnya,
sementara di permukaan luar kulit.

Penampilan kulit akan membantu dokter membuat diagnosis. Dokter mungkin juga
menyarankan tes darah, budaya luka atau tes lainnya untuk membantu
menyingkirkan gumpalan darah di dalam pembuluh darah kaki. Selulitis di tungkai
bawah ditandai dengan tanda dan gejala yang mungkin serupa dengan bekuan
terjadi jauh di dalam pembuluh darah, seperti kehangatan, nyeri dan pembengkakan
(inflamasi).

Ini memerah kulit atau ruam mungkin sinyal infeksi lebih dalam, lebih serius dari
lapisan dalam kulit. Setelah di bawah kulit, bakteri dapat menyebar dengan cepat,
memasuki kelenjar getah bening dan aliran darah dan menyebar ke seluruh tubuh.

Dalam kasus yang jarang terjadi, infeksi dapat menyebar ke lapisan dalam dari
jaringan yang disebut lapisan fasia. Necrotizing fasciitis, juga disebut oleh media
bakteri pemakan daging, adalah contoh dari infeksi yang mendalam-lapisan. Ini
merupakan keadaan darurat medis ekstrim.

Gejala Sakit mata selulitis Orbitalis

Sakit mata selulitis Orbitalis (SO) memiliki gejalan yaitu seperti :

-Mata Merah

-Mata nyeri

-Kelopak mata bengkak

-Bola mata menonjol dan bengkak

-Demam

-Tampak berkabut
Pemeriksaan untuk penyakit Sakit mata selulitis Orbitalis (SO) ini bisa dicek melalui
rontgen gigi dan mulut atau CT Scan sinus. SO yang tak segera ditangani bisa
berakibat fatal, seperti kebutaan, infeksi otak atau pembekuan darah di otak.

Penanganan Sakit mata selulitis Orbitalis

Penanganan gejala sakit mata selulitis orbitalis dapat dilakukan tindakan yaitu :

-Penderita sakit mata selulitis orbitalis diberikan antibiotika secara oral.

-Penderita sakit mata selulitis orbitalis bisa diberikan operasi pembedahan untuk
mengeluarkan nanah

Diagnosa Selulitis Orbitalis

Mendiagnosa harus ditegakkan berdasarkan gejala dan hasil pemeriksaan fisik.

Untuk menentukan penyebabnya bisa dilakukan rontgen gigi dan mulut atau CT
scan sinus.
Contoh jaringan dari selaput mata, kulit, darah, tenggorokan atau sinus bisa
dibiakkan di laboratorium untuk menentukan bakteri penyebab infeks tersebuti.

Cara Mengobati Selulitis Orbitalis

Pengobatan dilakukan adalah pada kasus yang ringan diberikan antibiotik per-oral
dan untuk kasus yang berat antibiotik diberikan secara intravena (melalui pembuluh
darah). Kadang perlu dilakukan pembedahan untuk membuang nanah atau
mengeringkan sinus yang terinfeksi
 Periorbital and Orbital Cellulitis

Presentation

Management - Orbital Cellulitis

This is a surgical emergency. After consultation with the ENT surgeons and ophthalmologists, an urgent CT scan
should be arranged to differentiate those patients with an associated abscess (usually subperiosteal) from those
without. This should be discussed with the radiologist who will ask for coronal views. Imaging should pay particular
attention to the orbital and frontal regions as the abscess may be small.

Surgical drainage of an abscess results in decompression of the orbit and obtains infected material for Gram stain
and culture.

Likely organisms include Strep pyogenes, Strep pneumoniae and Staph aureus. Over 5 years Staph aureus is more
common. Haemophilus influenzae type b is less common since HiB immunisation.

Recommended antibiotics

i.v. Ceftriaxone 50 mg/kg/dose (2g) iv 12H

and
i.v. flucloxacillin 50 mg/kg/dose 6-hourly (maximum 2 g/dose).

Lumbar puncture is contraindicated in patients with orbital cellulitis until after the CT scan has been performed,
even in the absence of features of raised intracranial pressure, since intracranial extension may be silent.

Management - Periorbital Cellulitis

Investigation of these patients should include FBE, blood cultures.

Likely organisms include Strep pyogenes, Strep pneumoniae and Staph aureus. Strep pyogenes and Staph aureus
are likely if there is a contiguous skin lesion. Rarely Haemophilus influenzae may be the cause particularly in
children under five who are not fully immunised.

Haemophilus bacteraemia-induced periorbital cellulitis and Haemophilus meningitis occasionally coexist. The
decision as to whether a lumbar puncture should be performed should be a clinical one.
Recommended antibiotics

Mild Amoxycillin/Clavulanate
(400/57 mg per 5 mL)
0.3 mL/kg (11 mL) po 12H

Moderate Flucloxacillin 50 mg/kg (2 g) iv 6H

Severe, Flucloxacillin 50 mg/kg (2 g) iv 6H

or <5y & not Hib immunised and

Ceftriaxone 50 mg/kg/dose (2g) iv 12H

In children who are systemically unwell it may be reasonable to use both Ceftriaxone 50 mg/kg/dose (2g) iv 12H
and flucloxacillin initially. Any child in whom there is a reasonable suspicion of primary skin infection, or who is not
improving on Ceftriaxone 50 mg/kg/dose (2g) iv 12H alone should have flucloxacillin added. Failure to respond in
24-48 hours may indicate orbital cellulitis or underlying sinus disease. Treat as for orbital cellulitis.

When improving, and no organism identified change to augmentin 25 mg/kg/dose, 8-hourly (maximum 500
mg/dose) for 7 days.

Prophylaxis
 If Haemophilus influenzae type b is isolated, rifampicin prophylaxis should be given as for meningitis, that is, if a
child aged 5 years or less lives in the same household as the index case or if the index case is < 2 yr, then
prophylaxis should be given to the entire household, including the index case. Parents who are pregnant should
not be given rifampicin. Patients should be warned that rifampicin will colour the urine tears and other secretions
orange, orange tears may discolour contact lenses. Rifampicin induces the metabolism of the oral contraceptive
pill making this form of contraception unreliable.

Doses:

< 1 month: 10 mg/kg once daily for 4 days

> 1 month: 20 mg/kg once daily for 4 days
Adults: 600 mg once daily for 4 days
All children aged < 5 yr who have not been immunised against Hib should be vaccinated. If children are < 2 yr and
have had a documented Haemophilus infection they should be immunised.

Local allergic reactions

In the absence of local and systemic signs of infection eg temperature or tenderness, periorbital erythema
may be an allergic reaction rather than periorbital cellulitis.

What is orbital cellulitis?

Orbital cellulitis is an infection or inflammation of the orbit. Since the orbit has direct communications with the sinuses, infection can
spread into the orbit in a patient with a sinus infection. Orbital cellulitis is potentially much more serious than preseptal cellulitis.

What causes orbital cellulitis?

Spread of infection is the most common cause of orbital cellulitis. Causes include:
 Sinusitis (the most common cause)
Trauma or foreign body
Infection from the blood
Tooth abscess

How is orbital cellulitis evaluated?

A history and physical examination is performed. Blood may be tested for infection. An imaging study (CT scan or MRI) may be
obtained to evaluate for spread into and possibly beyond the orbit.

How is orbital cellulitis treated?

Treatment for orbital cellulitis usually involves admission to the hospital for close observation and intravenous antibiotic therapy.
Consultation by an Ophthalmologist and possibly an Ear-Nose & Throat specialist are often recommended . Surgery to drain the
orbital and sinus infection may be necessary if the condition does not improve or worsens. Patients are monitored carefully for loss
of vision or evidence of pressure on the optic nerve.

What are the complications of orbital cellulitis?

Spread to surrounding tissue can cause significant worsening of the illness. Spread to the brain from the sinuses and orbit may
cause a brain abscess (walled off infection), meningitis (infection in tissues surrounding the brain) and/or hydrocephalus (increased
pressure in the brain). These serious complications often require intensive care and possibly emergency surgery. Rarely, these
complications may result in death.However, orbital cellulitis usually responds to proper treatment and there is generally full recovery

Eye Socket Infection (Orbital Cellulitis)

What is orbital cellulitis?

Orbital cellulitis is a severe infection inside your eye socket, which is called the orbit.

Orbital cellulitis is an emergency. It can cause permanent blindness if not treated right away.
What is the cause?
Eye socket infections can start after a surgery or an injury to the eye. Sinus or dental infections, or skin infections around your eye
and eyelids can spread to your eye socket through the thin bones and veins near your eye. Also, an infection that starts somewhere
else in your body can spread through the bloodstream to your eye.

Eye socket infections are usually caused by bacteria. Fungus may cause this infection if you have if your immune system is
weakened by diabetes, HIV, chemotherapy, or other conditions. Fungus is a kind of germ. It includes things like yeast, mold, and
mildew.

What are the symptoms?

Symptoms may include:

Decreased vision or double vision

Pain, swelling, and redness in and around your eye
Watery, yellow, or green discharge from your eye
Fever
Problems moving your eye in one or more directions
One eye looks like it bulges forward compared to the other eye

You may have a runny nose or a stuffy nose with these symptoms.

How is it diagnosed?
Your eyecare provider will ask about your symptoms and medical history, and do exams and tests such as:

An exam using a microscope with a light attached, called a slit lamp, to look closely at the front and back of your eye
An exam using drops to enlarge, or dilate, your pupils and a light to look into the back of your eyes
CT scan, which uses x-rays and a computer to show detailed pictures of your eye socket
 MRI, which uses a strong magnetic field and radio waves to show detailed pictures the bones and tissues of your eye socket
and sinuses
Lab tests of the discharge from your eye
Blood tests to check for signs of infection and bacteria in the blood

How is it treated?
If the infection is found and treated quickly, you may have no loss of vision. You may need to stay in the hospital and receive
medicines to treat the infection through an IV. You may need surgery to drain the infection.

How can I take care of myself?

Follow the full course of treatment your healthcare provider prescribes. Ask your healthcare provider:

How and when you will hear your test results

How long it will take to recover
What activities you should avoid and when you can return to your normal activities
How to take care of yourself at home
What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

How can I prevent an eye socket infection?

If you think you have an infection of the skin around your eye or of your eyelids, contact your healthcare provider. If you have a
history of sinus infections and develop eye symptoms, you should also seek medical attention.

Selulitis Orbita Akut

o Suatu keadaan akut dari jaringan orbita yang disebabkan oleh kuman.

o Kuman yang sering menyebabkan sinusitis atau dakrioadenitis seperti pneumokok, streptokok atau stafilokok.
 o Infeksi dapat terjadi secara langsung dari radang sinus paranasalis, melalui pembuluh darah & trauma terutama bila
ada benda asing yang masuk ke jaringan orbita.

o Gejala klinis:

- Nyeri.
Nyeri orbita terutama dirasakan penderita pada perabaan & pergerakan bola mata.
- Palpebra bengkak & merah.
- Penurunan visus
- Proptosis
- Gangguan pergerakan bola mata
- Diplopia
- Panas badan.
Penatalaksanaan:

- Isterahat total
- AB spectrum luas
- Infeksi local dicari dan diobati
- Insisi abses pada tempat fluktuasi

a. Selulitis Orbita

Selulitis orbita merupakan peradangan supuratif jaringan ikat longgar intraorbita di belakang septum orbita. Selulitis orbita akan
memberikan gejala demam, mata merah, kelopak sangat edema dan kemotik, mata proptosis, atau eksoftalmus diplopia, sakit
terutama bila digerakkan, dan tajam penglihatan menurun bila terjadi penyakit neuritis retrobulbar. Pada retina terlihat tanda
stasis pembuluh vena dengan edema papil.

DATA PENYAKIT, Deskripsi

Orbital selulitis adalah infeksi yang berpotensi terhadap komplikasi serius yang berbahaya. Bakteri dari infeksi sinus (sering
Haemophilus influenzae) biasanya menginfeksi anak-anak. Bakteri Staphylococcus aureus, Streptococcus pneumoniae, dan beta-
hemolitik streptokokus orbit juga dapat menyebabkan selulitis. Penyebab lainnya termasuk tembel di kelopak mata, gangguan
gigitan, atau kelopak mata cedera.

Anak umur 6-7 sangat rentan terhadap terinfeksi. Namun, tingkat orbital selulitis telah menurun terus sejak diperkenalkannya
Vaksin Hib (Haemophilus influenzae B). Orbital infeksi selulitis pada anak-anak dapat memburuk dengan sangat cepat dan dapat
menyebabkan kebutaan. Perhatian medis segera diperlukan.

Gejala
* Demam, umumnya 102 derajat F atau lebih tinggi
* Menyakitkan pembengkakan kelopak mata atas dan bawah
* Mengkilat, merah atau ungu kelopak mata
* Mata sakit, terutama dengan gerakan
* Penurunan pandangan
* Mata melotot
* General malaise
* Sakit atau sulit menggerakan mata

Pengobatan
Pasien biasanya perlu tinggal di rumah sakit. Perawatan termasuk antibiotik diberikan melalui vena. Pembedahan mungkin
diperlukan untuk mengeringkan abses. Orbital infeksi selulitis dapat menjadi lebih buruk dengan sangat cepat. Pasien harus
diperiksa setiap beberapa jam.

Selulitis Orbita
A.

Definisi
Selulitis orbita adalah peradangan supuratif jaringan ikat jarang intraorbita di belakang septum orbita.
1
Selulitis orbita jarang merupakan penyakit primer rongga orbita. Biasanya disebabkan oleh kelainan pada sinusparanasal dan yang terutama
adalah sinus etmoid. Selulitis orbita dapat mengakibatkan kebutaan, sehinggadiperlukan pengobatan segera. Pada anak-anak, selulitis orbitais
biasanya berasal dari infeksi sinus dandisebabkan oleh bakteri Haemophilus influenzae. Bayi dan anak-anak yang berumur dibawah 6-7
tahuntampaknya sangat rentan terhadap infeksi oleh Haemophilus influenzae.
2
B.

Epidemiologi
Peningkatan insiden selulitis orbita terjadi di musim dingin, baik nasional maupun internasional, karenapeningkatan insiden sinusitis dalam
cuaca. Ada mencatat peningkatan frekuensi selulitis orbita pada masyarakatdisebabkan oleh infeksi Staphylococcus aureus yang resisten
methicillin.1.

Mortalitas / MorbiditasSebelum ketersediaan antibiotik, pasien dengan selulitis orbita memiliki angka kematian dari

17%, dan 20% dari korban yang selamat buta di mata yang terkena. Namun, dengan diagnosis yangcepat dan tepat penggunaan antibiotik, angka
ini telah berkurang secara signifikan; kebutaan terjadidalam 11% kasus. Selulitis orbita akibat S. aureus yang resisten terhadap methicillin
dapatmenyebabkan kebutaan meskipun telah diobati antibiotik.2.

RasSelulitis orbita tidak dipengaruhi oleh rasial.3.

SexTidak ada perbedaan frekuensi antara jenis kelamin pada orang dewasa, kecuali untuk kasus-kasus S. aureus yang resisten terhadap
methicillin, yang lebih sering terjadi pada wanita daripada laki-laki dengan rasio 4:1. Namun, pada anak-anak, selulitis orbita telah dilaporkan
dua kali lebih sering

terjadi pada laki-laki daripada perempuan.4.

UsiaSelulitis orbita, pada umumnya, lebih sering terjadi pada anak-anak daripada di dewasa muda.Kisaran usia anak-anak yang dirawat di rumah
sakit dengan selulitis orbita adalah 7-12 tahun.
Etiologi dan Patofisiologi
Selulitis orbita merupakan peradangan supuratif yang menyerang jaringan ikat di sekitar mata,dan kebanyakan disebabkan oleh beberapa jenis
bakteri normal yang hidup di kulit, jamur, sarkoid, daninfeksi ini biasa berasal dari infeksi dari wajah secara lokal seperti trauma kelopak mata,
gigitan hewanatau serangga, konjungtivitis, kalazion serta sinusitis paranasal yang penyebarannya melalui pembuluhdarah (bakteremia)
dan bersamaan dengan trauma yang kotor.Pada anak-anak infeksi selulitis sering disebabkan oleh karena sinusitis etmoidalis yangmengenai anak
antara umur 2-10 tahun. Ada Beberapa bakteri penyebab, diantaranya :
a.

Haemophilus influenzae
Merupakan bakteri yang bersifat gram negatif dan termasuk keluarga Pasteuracella. Haemophilusinfluenzae yang tidak berkapsul banyak
diisolasi dari cairan serebrospinalis, dan morfologinya sepertiBordetella pertussis penyebab batuk rejan, namun bakteri yang didapat dari dahak
besifat pleomorfik dan sering berbentuk benang panjang dan filamen.Gambar
Haemophilus influenzae
yang diperoleh dari dahak.Ha
emophillus influenzae dapat tumbuh dengan media heme oleh karena media ini merupakan
media kompleks dan mengandung banyak prekursor-prekursor pertumbuhan khususnya faktor X(hemin) dan faktor V( NAD dan NADP ). Di
laboratorium di tanam dalam agar darah cokelat yang sebelumnya media tanamtersebut dipanaskan dalam suhu 80
o
C untuk melepaskan faktor pertumbuhan tersebut. Bakteri dapattumbuh dengan baik pada suhu 35
o
C- 38
o
C dengan PH optimal sebesar 7,6. Bakteri ini dapat tumbuhpada kondisi aerobik ( sedikit CO
2
). Bakteri ini sekarang sudah jarang untuk menyebabkan selulitisakibat banyaknya tipe vaksinasi untuk strain ini

Selulit Mata?
Oleh : Dr. Dito Anurogo

28-Mar-2008, 13:07:16 WIB - [www.kabarindonesia.com]

KabarIndonesia - Yang dimaksud dengan selulit mata disini adalah selulitis orbita. Jadi amat jauh berbeda dari selulit menurut pengertian awam. Mari kita pahami
apa itu selulitis orbita.
Definisi:
Selulitis orbita adalah peradangan jaringan ikat yang terdapat di dalam rongga orbita.

Penyebab:
1. Kuman piogenik (Pneumococcus, Staphylococcus, dan
Streptococcus).
2. Lues, jamur, dan sarkoid dapat menyebabkan selulitis orbita
kronik.
3. Haemophilus influenzae menyebabkan selulitis orbita pada anak.
4. Staphylococcus aureus dan Streptococcus sp. menyebabkan selulitis
orbita pada pada orang dewasa.
5. Trauma tembus yang kotor yang masuk ke dalam rongga orbita.

Manifestasi Klinis:
1. Badan terasa panas
2. Tajam penglihatan (visus) menurun
3. Penglihatan ganda (diplopia)
4. Daerah yang meradang terasa sakit, terutama pada perabaan.
5. Kelopak mata merah dan bengkak.
7. Konjungtiva bulbi berwarna merah.
8. Pada perabaan bola mata terasa sangat sakit.
9. Terkadamg bola mata sama sekali tidak dapat digerakkan.
10. Terkadang terlihat perdarahan papil akibat tekanan dari
belakang bola mata.
11. Malaise (tubuh merasa tidak enak, tidak nyaman)
12. Leukositosis (sel darah putih meningkat karena infeksi)
13. Keadaan umum penderita biasanya buruk sekali.

Penatalaksanaan:
1. Istirahat penuh/total dengan dirawat
2. Antibiotik dosis tinggi intravena atau intramuskular yang sesuai.
3. Jika perlu, abses dikeluarkan. Namun hati-hati, karena dapat
menimbulkan penyulit baru.

Penyulit:
1. Trombosis sinus kavernosus
2. Meningitis
3. Abses otak
4. Panoftalmitis
5. Neuritis

Prognosis:
Sukar diramalkan.
Bila pengobatan terlambat, hasilnya lebih buruk.

Tahukah Anda?

1. Selulitis orbita jarang merupakan penyakit primer rongga orbita. Biasanya disebabkan oleh kelainan pada sinus paranasal dan yang terutama adalah sinus etmoid.

2. Selulitis orbita dapat mengakibatkan kebutaan, sehingga diperlukan pengobatan segera.