EYE DISEASES RELATED TO

FOCAL DENTAL INFECTION

Laksmi Utari
Introduction

• Dental infection sometime can spread to another part

of the body, such as eye and brain
• Mostly haematogenous (via vein  valveless)

Direct spread Spread of

of pathogen inflammatory cells
Cellulitis
• Diffuse inflammation of peri-orbital soft tissue
• Pathogenesis:
• Dental infection spread through the maxillary sinus into
the inferior orbit via the inferior orbital fissure or defect in
the orbital floor
• extension via the pterygopalatine regions, infection
ascending from the canine fossa to the orbit, or
retrograde spread through the ophthalmic vein
  Sign & symptom:
Pain, tenderness, redness,
diffuse edema and
restricted eye opening

 Treatment:
Antibiotics and removal of
the cause of infection

A 14-year-old boy with left periorbital

cellulitis and a tooth abscess

Andrea Hauser, Simone Fogarasi. 2010. Periorbital and Orbital Cellulitis. Pediatrics in review, June
2010; vol 31;issue 6.
 EPISCLERITIS AND SCLERITIS

• Chronic inflammation that involves the outermost coat

and skeleton of the eye
• Associated with a systemic, immune-mediated disease;
infection, drug reaction, tumor, or complications following
surgery
• Increased systemic inflammation related to periodontitis
may have played a role as the initiating factor for scleritis

Guliz Nigar Guncua and Feriha Caglayana. 2011. Resolution of Anterior Scleritis after Periodontal
Therapy. Eur J Dent 5(3):337-339
EPISCLERITIS AND SCLERITIS
1. Episcleritis
• Simple
• Nodular
2. Anterior scleritis
• Non-necrotizing diffuse
• Non-necrotizing nodular
• Necrotizing with inflammation
• Necrotizing without inflammation
( scleromalacia perforans )

3. Posterior scleritis
 Applied anatomy of vascular coats
Normal Episcleritis Scleritis

• Radial superficial episcleral • Maximal congestion • Maximal congestion of

vessels of episcleral vessels deep vascular plexus
• Deep vascular plexus • Slight congestion of
adjacent to sclera episcleral vessels
 Simple episcleritis
• Common, benign, self-limiting but frequently recurrent
• Typically affects young adults
• Seldom associated with a systemic disorder

Simple sectorial episcleritis Simple diffuse episcleritis

Treatment
• Topical steroids
 Nodular episcleritis
• Less common than simple episcleritis
• May take longer to resolve
• Treatment - similar to simple episcleritis

Localized nodule which can be moved over sclera Deep scleral part of slit-beam
not displaced
Diffuse anterior non-necrotizing scleritis
• Relatively benign - does not progress to necrosis
• Widespread scleral and episcleral injection

Treatment
• Oral NSAIDs
• Oral steroids if unresponsive
Nodular anterior non-necrotizing scleritis
More serious than diffuse scleritis

On cursory examination resembles Scleral nodule cannot be moved over

nodular episcleritis underlying tissue
Treatment - similar to diffuse non-necrotizing scleritis
Anterior necrotizing scleritis with inflammation
• Painful and most severe type
• Complications - uveitis, keratitis, cataract and glaucoma
Progression

Avascular patches Scleral necrosis and Spread and coalescence

visibility of uvea of necrosis
Treatment
• Oral steroids
• Immunosuppressive agents (cyclophosphamide, azathioprine, cyclosporin)
• Combined intravenous steroids and cyclophosphamide if unresponsive
Anterior necrotizing scleritis with inflammation
(scleromalacia perforans)
• Associated with rheumatoid arthritis
• Asymptomatic and untreatable

Progressive scleral thinning with exposure of underlying uvea

 Posterior scleritis
• About 20% of all cases of scleritis
• About 30% of patients have systemic disease
• Treatment similar to necrotizing scleritis with inflammation
Signs

Proptosis and Disc swelling Exudative retinal

ophthalmoplegia detachment

Ring choroidal detachment Choroidal folds Subretinal exudation

 Imaging in posterior scleritis
Ultrasound Axial CT
a a

a - Thickening of posterior sclera Posterior scleral thickening

b -Fluid in Tenon space (‘T’ sign)
UVEITIS

• Inflammation of the uveal tract

• IRITIS
• CYCLITIS
• CHOROIDITIS
• PANUVEITIS
UVEITIS
• Etiology:
• Unknown (idiopathic)
• Autoimmune
• Arthritis reumatoid juvenile
• Infection (bacteria, viral, fungi)
• Symptom:
• Light sensitivity
• Pain
• watery
• Blurry vision

• Sign:
• Siliar injection on the limbus
• Pupil miosis, flare, cell and
posterior synechia.
• Keratik Precipitate: protein
and inflammatory cell on
the corneal endothel.
 KERATIK PRESIPITATE

Pupil irregular
Posterior synechia
Iris pigmen
Keratik presipitate
Posterior Uveitis

Funduscopy: choroid lesion:

1. Pigmentation
2. Exudate
3. Sklera ( white )
4. E/ toxoplasmosis
 Management:
• Find the etiology
• Treat the focal infection
• Local : midriatikum eyedrop
Steroid eyedrop
• Systemic: depend on the etiology
If there is no contraindication, give
steroid (carefull on TB, DM)
 Optic Neuritis

• Inflammation of the optic nerve

• Etiology:
• Multiple sclerosis
• Autoimmune
• Infection (tooth abscess in upper jaw, syphilis,
herpes)
• Injury to the optic nerve
Pathology
Perivascular infiltrate of
inflammatory cells

Destruction of myelin
• Symptom
• Blurry vision
• Pain
• Loss of color
vision
• Flashing light

 Management:
 Systemic corticosteroid (i.v and oral)  ONTT
 Treat focal infection
 Conclusion
• Early recognition and prompt management of orbital infection of
dental origin is of great importance

• But final optimum results can only be achieved by treating the focal
infection