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Introduction
* Chronic sinusitis is an inflammation of the sinuses lasting more than six weeks.
7- Immune system cells. (eosinophils can cause sinus inflammation). 8- Other medical conditions. The complications of cystic fibrosis, gastroesophageal reflux, or HIV and other immune system diseases may result in nasal blockage.
Sinonasal disease accounts for the majority of orbital infections (up to 85%).
- The frontal, maxillary, ethmoid and sphenoid sinuses sit immediately above, below, between and behind the eyes, respectively.
For this reason, infections of any of the sinuses may spread to the orbit, causing a wide spectrum of complications from mild inflammation of the eyelid to abscesses with possible blindness.
- Most of the complications follow infection of ethmoids as they are separated from the orbit only by a thin lamina of bone~ lamina papyracea. - Infection travels from these sinuses either by osteitis or as thrombophlebitic process of ethmoidal veins.
Orbital complications as staged by Chandler (1970) are: preseptal cellulitis, orbital cellulitis, subperiosteal abscess, orbital abscess, and cavernous sinus thrombosis (dural thrombophlebitis).
Inflammatory Oedema of Lids . Subperiosteal Abscess . Orbital Cellulitis . Orbital Abscess . Superior Orbital fissure syndrome .
Subperiosteal Abscess
- Pus collects outside the bone under the Periosteum. - A subperiosteal abscess from ethmoids forms on the medial wall of orbit and displaces the eyeball forward, downward and laterally.
- From the frontal sinus, abscess is situated just above and behind the medial canthus and displaces the eyeball downwards and laterally.
- From the maxillary sinus, abscess forms in the floor of the orbit and displaces the eyeball upwards and forwards.
Orbital Cellulitis
- When pus breaks through the periosteum and finds its way into the orbit, it spreads between the orbital fat, extraocular muscles, vessels and nerves. - Clinical features will include oedema of lids, exophthalamos, chemosis of conjunctiva and restricted movements of the eye ball.
- Vision is affected causing partial or total loss which is sometimes permanent. - Patient may run high fever. - Orbital cellulitis is potentially dangerous because of the risk of meningitis and cavernous sinus thrombosis.
Orbital Abscess
- Intraorbital abscess usually forms along lamina papyracea or the floor of frontal sinus. - Clinical picture is similar to that of orbital cellulitis.
- Diagnosis can be easily made by CT scan or ultrasound of the orbit. - Treatment is i.v. antibiotics and drainage of the abscess and that of the sinus (ethmoidectomy or trephination of frontal sinus).
Evaluation
It should include a thorough ophthalmologic examination and thin cut CT with contrast of the orbits and paranasal sinuses.
Treatment
- Local and systemic decongestion play an important role.
- Surgical intervention is frequently required and should be considered as indicated. - Frank abscesses should be evacuated urgently.
- Small subperiosteal abscesses with normal vision, normal EOMI, mild proptosis may be treated conservatively with IV antibiotics. - All patients with orbital complications managed medically should be closely observed with frequent visual checks.
- Patients who experience a decrease in visual acuity, worsening extraocular muscle function or failure to improve in 48-72 hours should undergo surgical sinus drainage.