Orbital cellulitis is a serious bacterial infection affecting the soft tissues and fat within the eye socket, behind the orbital septum. This condition can cause pain, swelling around the eye, and a protruding eye, also known as proptosis. It is distinct from preseptal cellulitis, which involves only the eyelid and surrounding skin. Prompt diagnosis and treatment are important as orbital cellulitis can worsen quickly, leading to severe complications.
When Surgery Becomes Necessary
Initial treatment for orbital cellulitis involves intravenous antibiotics, administered immediately due to the infection’s severity and rapid spread. Surgery becomes necessary when medical treatment is insufficient or complications arise. Lack of improvement or worsening symptoms after 24-48 hours of antibiotic therapy indicates the need for surgical intervention.
The presence of an abscess, either subperiosteal (between the bone and the periosteum) or intraorbital (within the eye socket), necessitates surgical drainage. CT scans identify these fluid collections and assess their size and location. A large subperiosteal abscess, especially in adults, indicates surgery.
Other factors prompting surgery include decreased vision, an afferent pupillary defect, or progression of proptosis despite antibiotic treatment. If a CT scan shows completely opacified sinuses or if the abscess size does not reduce within 48-72 hours of antibiotic administration, surgery may be performed. These indicators show the infection is not responding to medication and poses a direct threat to vision or infection spread.
Understanding the Surgical Procedures
Surgical approaches for orbital cellulitis focus on draining abscesses, relieving pressure, and removing infected tissue. Incision and drainage (I&D) of an abscess is a common procedure, performed through external or endoscopic approaches depending on the abscess’s location and size. The goal is to remove pus and infected fluid, reducing inflammation and allowing antibiotics to work more effectively.
For abscesses located medially, near the nose, an endoscopic approach through the nasal cavity may be used. Abscesses in other locations might require an external incision near the eye. If the infection causes tissue death (necrotic tissue), debridement removes this damaged tissue, preventing further spread.
If the infection causes significant swelling and pressure on the optic nerve, leading to vision changes or loss, orbital decompression may be necessary. This procedure involves removing bone or tissue to create more space within the orbit, alleviating pressure on the optic nerve and preserving vision. Drains are left in place for several days after surgery for continued fluid drainage. For fungal infections, surgical debridement of the orbit, potentially involving eye removal, is indicated with antifungal therapy.
Recovery and Post-Operative Care
Following orbital cellulitis surgery, patients can expect hospitalization until their fever subsides and their clinical condition improves. Intravenous antibiotic treatment continues for one to two weeks after surgery to ensure infection eradication. This is followed by two to three weeks of oral antibiotics.
Pain management is an important aspect of post-operative care, with medications prescribed for comfort during recovery. Wound care involves keeping the surgical site clean and monitoring for complications like increased redness, swelling, or discharge. Healthcare professionals regularly monitor for symptom improvement, such as reduced eye swelling and improved eye movement.
Follow-up appointments with an ophthalmologist, an ear, nose, and throat (ENT) specialist, and an infectious disease specialist are important to monitor progress. These appointments allow for healing assessment, antibiotic therapy adjustment if needed, and early detection of recurrence or long-term issues. Patients with severe cases may have a longer recovery, and repeat surgery might be required.
Potential Risks and Long-Term Outlook
Orbital cellulitis surgery carries potential risks. These include bleeding, further infection at the surgical site, or damage to surrounding eye structures. Damage to the optic nerve could lead to permanent vision changes or loss, while injury to extraocular muscles might affect eye movement and cause double vision.
Timely surgical intervention significantly improves the long-term outlook. Without prompt treatment, orbital cellulitis can lead to severe complications like permanent vision loss, infection spread to the brain causing meningitis or intracranial abscesses, or blood clots in the cavernous sinus. Successful surgery, combined with antibiotic therapy, leads to a good prognosis, with most patients recovering without lasting severe complications.
Early diagnosis and treatment are important for preventing permanent damage and ensuring a positive outcome. Even after successful treatment, individuals prone to recurring sinus infections should monitor and treat these conditions quickly to prevent orbital cellulitis recurrence. This proactive approach helps to maintain long-term eye health and overall well-being.