Bilateral orbital cellulitis: A case report and management challenges

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Date: January-June 2017
From: Nigerian Journal of Ophthalmology(Vol. 25, Issue 1)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Case study
Length: 2,760 words
Lexile Measure: 1630L

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Byline: Eberechukwu. Achigbu, Kingsley. Achigbu

To report a case of bilateral orbital cellulitis in a conscious 11-year-old Nigerian girl and the management challenges. Bilateral orbital cellulitis secondary to rhinosinusitis is uncommon but has been reported in the literature in other countries where the diagnosis was made with the aid of necessary tools such as the computerized tomography scan among others. In this case, the challenge associated with the management of the index child is a reflection of the difficulties encountered in the treatment of patients in the developing countries and the importance of a good clinical judgment, early diagnosis, and prompt intervention in the management of bilateral orbital cellulitis. This is a case report of an 11-year-old Nigerian girl of the Igbo tribe. She presented with painful progressive protrusion of the eyeballs and swelling of the lids of 3 days duration. The left eyeball protruded 2 days after the right with no associated history of altered sensorium. A working diagnosis of bilateral orbital cellulitis secondary to rhinosinusitis was made. She was placed on parenteral and topical antibiotics until she recovered. Bilateral orbital cellulitis occurring in a conscious child is uncommon. Prompt and specific treatment should be started empirically, especially in developing countries where the facilities for investigation may not be available or the patients may be financially handicapped. This is particularly important to prevent the possible loss of vision and severe life-threatening complications. This study will be of interest particularly to the ophthalmologists, the otorhinolaryngologists, and the pediatricians.

Introduction

Orbital cellulitis is a common life-threatening infection of the postseptal tissues of the orbit and one of the common causes of orbital inflammation. It occurs most commonly in children and young adults.[sup][1],[2] As many as 11% of cases of orbital cellulitis result in visual loss.[sup][3]

Orbital cellulitis is an acute inflammatory disorder of the orbit. It is thought to occur as a result of an acute spread of infection from the blood, adjacent sinuses, and facial skin.[sup][2] Periorbital trauma and dental infection are other sources of spread to the orbit.[sup][2]

Most cases seen in the hospital and reported in texts are unilateral, only involving the second eye if the cavernous sinus is involved. Direct spread of the disease through the ophthalmic veins to the cavernous sinus and centrifugally to the contralateral orbit through the dura mater has been postulated as the mechanism of involvement of the orbit resulting in bilateral orbital cellulitis.[sup][4],[5] Until recently, this was the only reported pathway to the development of bilateral orbital cellulitis and thus it influenced the classification of orbital cellulitis with bilateral involvement occurring at the late stages with cavernous sinus infection.[sup][6],[7] There are, however, more recent classifications, most of which are modifications of the classifications by Chandler et al. [sup][6] and Moloney et al. [sup][8] The latest proposal suggested incorporation of radiologic findings to the Moloney classification.[sup][9]

Regarding the management of orbital cellulitis, the standard protocol includes immediate hospitalization with prompt empirical medical intervention targeting the likely causative organisms with respect to the age...

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Gale Document Number: GALE|A494694553