Preseptal cellulitis
Preseptal cellulitis is a relatively common infection of the subcutaneous tissues located in front of the orbital septum.
Reasons
Staph. aureus after skin trauma or Beta hemolytic streptococcus inoculation
Spread of local infection such as acute hordoelum, dacryocystitis, conjunctivitis or sinusitis
Hematogenous spread from an existing infection in the upper respiratory tract or middle ear
Symptoms
One-sided, tender, red-colored, periorbital region and swelling of the lid.
Proptosis is not seen, visual acuity and ocular motility are not affected.
Oral methoxypenicillin and flucloxacillin are used for treatment.
Orbital Cellulite
• Infection of the soft tissues behind the orbital septum.
• The most common causative factors are Strep. pneumoniae, Staph. Aureus, Strep. Pyogenes and H. influenza
Reasons
Sinus-related: It is the most common type and most commonly develops secondary to ethmoid sinusitis.
Dacryocystitis, midfacial infections or dental infections can lead to orbital cellulitis through maxillary sinusitis.
It can be seen after trauma penetrating the orbital septum.
It can be seen after surgical interventions.
Symptoms
The eyelids are swollen, red and sensitive.
Proptosis is present.
Ocular movements are limited and painful.
Optic nerve dysfunction and vision loss may be present.
Treatment
The patient should be hospitalized and parenteral antibiotic therapy should be started.
Eye Muscles
Extrinsic muscles: Consists of four rectus muscles and two oblique muscles
Intrinsic muscles: ciliary muscle, sphincter and dilator pupillary muscles
Painful ophthalmoplegia + pseudotumor orbita = Talosa Hunt syndrome
|
Muscle |
Movement |
Nerve |
|
internal rectus |
Adduction (Add.) |
N. Oculomotorius(III) |
|
external rectus |
Abduction (abd) |
N. abducens(VI) |
|
lower rectus |
Depression, Extortion,
Add. |
N. Oculomotorius(III) |
|
upper rectus |
Elevation, Intorsion.abd
. |
N. Oculomotorius(III) |
|
upper oblique |
Intorsion, Depression,
abd. |
N. Trochlearis(IV) |
|
lower oblique |
Extortion, Elevation,
abd. |
N. Oculomotorius(III) |
Acute Bacterial Endophthalmitis
Acute endophthalmitis is a devastating complication with a rate of 1/1000.
Despite early treatment, 50% of eyes become blind.
In order of frequency, the organisms that most commonly cause this disease are Staph. Epidermidis, Staph. Aureus and Pseudomonas and Proteus species.
