Orbital Cellulitis

Orbital Cellulitis is an inflammation or infection of the eye socket or orbit. As such, the orbital septum is a fibrous membrane that separates the eyelid skin from the deeper structure of the orbit. Since the orbit has direct connection with the sinuses, infection can spread into the orbit in a patient with a sinus infection. Of the two – preseptal cellulitis and orbital cellulitis – the latter is potentially more serious. Both conditions are common in children and adults.

It is very difficult to distinguish between the two as in both the conditions; the eyelids are red and swollen. However, in preseptal cellulitis the eyes move normally and are positioned normally whereas in orbital cellulitis, there is a restriction of eye movements and the eye might appear protruding more than normal. There could be decrease in vision and pupil reaction also.

Causes for orbital cellulitis include sinusitis, trauma or foreign body, infection from blood and tooth abscess. An imaging study is done to evaluate the spread of the disease beyond the orbit, other than blood tests for infection.

Consultation is done with an ophthalmologist and ENT specialist. Treatment includes admission to the hospital for close observation and intravenous therapy with antibiotics. Immediate treatment with intravenous antibiotics is necessary to prevent optic nerve damage and spread of infection to the cavernous sinuses, meninges and brain. Penicillinase-resistant penicillin, such as nafcillin, is recommended, along with metronidazole or clindamycin to treat anaerobic infections. Surgery to drain the orbital and sinus infection may become necessary if the condition of the patient worsens. Patients are regularly monitored for any evidence for loss of vision and pressure on the optic nerve.

Orbital cellulitis can cause complications if the infection spreads to the surrounding tissue and worsens the illness. If it spreads to the brain, then brain abscess, meningitis or hydrocephalus may result. These require intensive care and emergency surgery. But orbital cellulitis responds to proper treatment and there is generally complete recovery.

Exophthalmos

Exophthalmos, also known as Proptosis, refers to a protrusion or bulging of one (unilateral) or both (bilateral) the eyeballs out of the orbit. Exophthalmos is not a medical condition in itself; but a sign or a symptom of some other disease. There are many underlying conditions that can result in exophthalmos, but most often it is caused by thyroid- related conditions such as Graves disease. Graves disease induced Exophthalmos is one of the manifestations of thyroid eye problems.

Exophthalmos caused due to Graves' disease is usually bilateral. Apart from thyroid problems, there are other conditions that may lead to Exophthalmos. They include cancerous tumor, Mucocoele (mucus-filled cyst), blood clot, trauma (eye injury), inflammation of the orbit structures and very rarely Retrobulbar hemorrhage (bleeding in the eye socket).

Signs and symptoms of Exophthalmos

Exophthalmos caused by Graves disease normally produces symptoms such as pain, watering, dryness, irritation, sensitivity to light, double vision and loss of vision. Tumor-induced exophthalmos presents itself with severe eye pain, headaches and double vision.

Diagnosis of Exophthalmos

Exophthalmos is easily noticeable by its appearance during clinical examination. Ophthalmologist uses exophthalmometer to measure the degree of bulging or protrusion. Blood tests are normally advised, if doctor suspects hypothyroidism, to evaluate thyroid gland function.

If the bulging has occurred in one eye, MRI or CT scan is done to rule out the presence of tumor. These tests also help in diagnosing Orbital cellulitis and Retrobulbar hemorrhage.

Treatment of Exophthalmos

Treating the exophthalmos at an early stage is essential as it is a progressive disease and if left untreated patient may be unable to close the eyes totally. This may dry out the cornea leading to infections and ulcers eventually resulting in vision loss.

In case of thyroid related exophthalmos, the aim of the treatment is to restore the thyroid function and bring the thyroid hormones to normal levels. Medications such as thionamides and radio iodine are given orally to treat overactive thyroid gland. In severe cases, corticosteroids are also administered to provide relief from pain and inflammation. Lubricants are also prescribed to treat dry, red and sore eyes. If the exophthalmos is caused by a tumor, treatments such as radiotherapy, chemotherapy and surgery may be appropriate.