Severe orbital cellulitis secondary to chronic sinusitis: challenges in saving the eye

Orbital cellulitis is a relatively common disease affecting predominantly the paediatric population. Most cases occur as a result of spread from the nearby sinuses. Other causes include penetrating trauma or extension from infected adjacent structures.If left untreated, this condition may result in...

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Main Authors:	Diymitra K Ganasan, Mushawiahti Mustapha, Aida Zairani Mohd Zahidin
Format:	Article
Language:	English
Published:	Pusat Perubatan Universiti Kebangsaan Malaysia 2018
Online Access:	http://journalarticle.ukm.my/12558/ http://journalarticle.ukm.my/12558/ http://journalarticle.ukm.my/12558/1/10._diymitra_et_al.pdf

id	ukm-12558
recordtype	eprints
spelling	ukm-125582019-02-14T21:37:15Z http://journalarticle.ukm.my/12558/ Severe orbital cellulitis secondary to chronic sinusitis: challenges in saving the eye Diymitra K Ganasan, Mushawiahti Mustapha, Aida Zairani Mohd Zahidin, Orbital cellulitis is a relatively common disease affecting predominantly the paediatric population. Most cases occur as a result of spread from the nearby sinuses. Other causes include penetrating trauma or extension from infected adjacent structures.If left untreated, this condition may result in devastating sequelae such as orbital apex syndrome, cavernous sinus thrombosis, meningitis, cranial nerve palsies, intracranial abscess formation and even death. A 47 year old immunocompetent Burmese lady presented with left eyelid swelling of 2 days duration associated with eye redness, blurring of vision and diplopia. Previously, there was history of right maxillary sinusitis and parapharyngeal abscess 9 months prior to presentation. On examination, she was afebrile with vision of 1/60 for the left eye with positiverelative afferent pupillary defect (RAPD). The eye was proptosed and swollen with restricted extraocular movements in all gazes. Conjunctiva was injected with chemosis and there was corneal epithelial bedewing. Otherwise anterior chamber was quiet and intraocular pressure was 51mmHg. Bilateral fundus examination was normal. Computed tomography (CT) scan of the orbit and paranasal sinus showed dense sinusitis and periosteal abscess at the lateral orbital wall.She was started on intravenous (IV) Cefuroxime and Metronidazole and underwent Functional Endoscopic Sinus Surgery (FESS) and orbital decompression. Intra-operatively there was pus and debris at the left anterior ethmoid, maxillary and sphenoid air sinuses and cultures revealed Klebsiella pneumoniae which was sensitive to Cefuroxime. Despite medical and surgical treatment, left orbital swelling only reduced minimally. However after starting intravenous Dexamethasone the swelling dramatically improved. She completed 10 days of intravenous Dexamethasone. Upon discharge, she was given oral Dexamethasone 2mg daily for 2 weeks and completed 2 weeks of oral Cefuroxime and Metronidazole. Intraocular pressure normalised and vision recovered to 6/9. A repeat CT orbit 3 weeks later showed resolving preseptal and periorbital collection. Pusat Perubatan Universiti Kebangsaan Malaysia 2018 Article PeerReviewed application/pdf en http://journalarticle.ukm.my/12558/1/10._diymitra_et_al.pdf Diymitra K Ganasan, and Mushawiahti Mustapha, and Aida Zairani Mohd Zahidin, (2018) Severe orbital cellulitis secondary to chronic sinusitis: challenges in saving the eye. Journal of Surgical Academia, 8 (1). pp. 47-50. ISSN 2231-7481 http://jsurgacad.com/toc/8/1
repository_type	Digital Repository
institution_category	Local University
institution	Universiti Kebangasaan Malaysia
building	UKM Institutional Repository
collection	Online Access
language	English
description	Orbital cellulitis is a relatively common disease affecting predominantly the paediatric population. Most cases occur as a result of spread from the nearby sinuses. Other causes include penetrating trauma or extension from infected adjacent structures.If left untreated, this condition may result in devastating sequelae such as orbital apex syndrome, cavernous sinus thrombosis, meningitis, cranial nerve palsies, intracranial abscess formation and even death. A 47 year old immunocompetent Burmese lady presented with left eyelid swelling of 2 days duration associated with eye redness, blurring of vision and diplopia. Previously, there was history of right maxillary sinusitis and parapharyngeal abscess 9 months prior to presentation. On examination, she was afebrile with vision of 1/60 for the left eye with positiverelative afferent pupillary defect (RAPD). The eye was proptosed and swollen with restricted extraocular movements in all gazes. Conjunctiva was injected with chemosis and there was corneal epithelial bedewing. Otherwise anterior chamber was quiet and intraocular pressure was 51mmHg. Bilateral fundus examination was normal. Computed tomography (CT) scan of the orbit and paranasal sinus showed dense sinusitis and periosteal abscess at the lateral orbital wall.She was started on intravenous (IV) Cefuroxime and Metronidazole and underwent Functional Endoscopic Sinus Surgery (FESS) and orbital decompression. Intra-operatively there was pus and debris at the left anterior ethmoid, maxillary and sphenoid air sinuses and cultures revealed Klebsiella pneumoniae which was sensitive to Cefuroxime. Despite medical and surgical treatment, left orbital swelling only reduced minimally. However after starting intravenous Dexamethasone the swelling dramatically improved. She completed 10 days of intravenous Dexamethasone. Upon discharge, she was given oral Dexamethasone 2mg daily for 2 weeks and completed 2 weeks of oral Cefuroxime and Metronidazole. Intraocular pressure normalised and vision recovered to 6/9. A repeat CT orbit 3 weeks later showed resolving preseptal and periorbital collection.
format	Article
author	Diymitra K Ganasan, Mushawiahti Mustapha, Aida Zairani Mohd Zahidin,
spellingShingle	Diymitra K Ganasan, Mushawiahti Mustapha, Aida Zairani Mohd Zahidin, Severe orbital cellulitis secondary to chronic sinusitis: challenges in saving the eye
author_facet	Diymitra K Ganasan, Mushawiahti Mustapha, Aida Zairani Mohd Zahidin,
author_sort	Diymitra K Ganasan,
title	Severe orbital cellulitis secondary to chronic sinusitis: challenges in saving the eye
title_short	Severe orbital cellulitis secondary to chronic sinusitis: challenges in saving the eye
title_full	Severe orbital cellulitis secondary to chronic sinusitis: challenges in saving the eye
title_fullStr	Severe orbital cellulitis secondary to chronic sinusitis: challenges in saving the eye
title_full_unstemmed	Severe orbital cellulitis secondary to chronic sinusitis: challenges in saving the eye
title_sort	severe orbital cellulitis secondary to chronic sinusitis: challenges in saving the eye
publisher	Pusat Perubatan Universiti Kebangsaan Malaysia
publishDate	2018
url	http://journalarticle.ukm.my/12558/ http://journalarticle.ukm.my/12558/ http://journalarticle.ukm.my/12558/1/10._diymitra_et_al.pdf
first_indexed	2023-09-18T20:02:53Z
last_indexed	2023-09-18T20:02:53Z
_version_	1777406965901688832

Severe orbital cellulitis secondary to chronic sinusitis: challenges in saving the eye

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