When orbital infection (OI) is suspected, patient history should be taken into account as some non-infectious etiologies can mimic the presentation of this disease. Hence, inquiries about recent insect stings, battles, trauma, allergies should be made. Furthermore, a survey about traveling, and any factors contributing to infection, like immunosuppressive medication use, chronic diseases is also significant. Patients with orbital infection may have had previous occasions of infections in structures anatomically close to the orbit e.g. a dental abscess or sinusitis. Likewise, respiratory system infections are known to be associated with OI [1].

Orbital infection is divided into five groups [2]:

1. Preseptal cellulitis
2. Orbital cellulitis
3. Subperiosteal abscess
4. Orbital abscess
5. Cavernous sinus thrombosis

Each group manifests in individual ways. For instance, preseptal cellulitis affects eyelids, thus clinical presentation is inflammation of the eyelid with edema, warmth, pain, and erythema [3].

Orbital cellulitis (OC) exhibits as inflammation of fat tissue surrounding the globe. In this case, the edematous lid will not show signs of inflammation, as edema arises from disrupted venous outflow. Additionally, eyelids can show signs of palsy due to compression of the oculomotor nerve. Other signs of orbital cellulitis are chemosis, displacement of the orbit (proptosis), as well as disturbed vision [1].

Subperiosteal abscess clinically presents as proptosis, restricted mobility of the eye, and sensations of pain during motion [2].

Orbital abscess presents with more serious proptosis, in addition to ophthalmoplegia, and disturbed visual acuity. Palsy of abducens nerve is possible resulting in diplopia or double vision [2].

Cavernous sinus thrombosis is characterized by bilateral photophobia, proptosis, ophthalmoplegia, hypoesthesia of the cornea. Paresis or palsy of cranial nerves IV and VI are seen as well [4].

Severe cases of orbital infection can cause complications like meningitis, infarction of orbital structures such as the optic nerve, sclera, choroid and retina. Infarction may arise due to compression of surrounding arteries with mass lesions or inflammation [5]. Glaucoma, although a rare manifestation, can present in OI by interfering with visual acuity [6].

• Soft Tissue Swelling

  Characteristic findings are bilateral, boggy, nontender, nondiscolored soft-tissue swelling. Allergic inflammation includes angioneurotic edema or contact hypersensitivity. ( 2 ) Superficially, these problems can resemble acute infection. [pedsinreview.aappublications.org]

  You also notice soft tissue swelling and redness around her left eye. And when you look at Irena in profile, you notice that her left eye protrudes anteriorly from the orbit. [coursera.org]

  CT scan orbit and paranasal sinuses showed the left eye to be proptosed, with extensive periorbital soft-tissue swelling consistent with orbital cellulitis. The adjacent sinuses were clear and without evidence of sinusitis ( Figure 1 ). [nature.com]

• Localized Edema

  Hypoproteinemia and congestive heart failure cause eyelid swelling due to local edema. Characteristic findings are bilateral, boggy, nontender, nondiscolored soft-tissue swelling. [pedsinreview.aappublications.org]

• Soft Tissue Mass

  Orbital cellulitis poor definition of orbital planes inflammatory stranding in the intraconal fat intraconal or extraconal soft tissue mass edema of the extraocular muscles intraorbital abscess subperiosteal abscess Endophthalmitis Findings are often [radiopaedia.org]

• Recurrent Bacterial Infection

  Erysipelas- acute, recurrent bacterial infection with large raised patches, especially on the face We cannot just assume that preseptal cellulitis is in fact preseptal. in order to determine if the infection has spread to the septum, what tests can we [brainscape.com]

• Hunting

  Tolosa-Hunt Syndrome - can be due to idiopathic orbital psuedotumor 2. orbital involvement in this case 3. loss of corneal reflex if V1 is involved, less stimulus for blinking causing dry eye 4. [brainscape.com]

• Eye Pain

  Cavernous sinus thrombosis: causes bilateral symptoms, including proptosis, eye pain, sensory deficits affecting the cornea, and bilateral orbital apex syndrome. B. [clinicaladvisor.com]

  If you’re experiencing any eye pain or vision problems, your doctor may order blood tests and take blood samples. An infection in your eye can cause serious complications. [healthline.com]

  pain Tenderness to touch of lids Mildly engorged conjunctival vessels Proptosis (in "post-septal cellulitis") Reduced eye movements (in "post-septal cellulitis") Diplopia (in "post-septal cellulitis") Reduced vision (in "post-septal cellulitis") [kellogg.umich.edu]

  Signs and symptoms include swelling and pain of the eyelids, pain in the eye, painful eye movements, decreased vision, and fever. It is a serious condition that requires immediate medical attention. [fpnotebook.com]

  A 9-Year old Who Has Fever, Headache, and Right Eye Pain. Pediatrics in Review September 2005 Hauser A, Fogarasi S. Periorbital and Orbital Cellulitis. Pediatrics in Review. June 2010. Seltz LB et al. [pedclerk.bsd.uchicago.edu]

• Diplopia

  Palsy of abducens nerve is possible resulting in diplopia or double vision. Cavernous sinus thrombosis is characterized by bilateral photophobia, proptosis, ophthalmoplegia, hypoesthesia of the cornea. [symptoma.com]

  Suspicion of Anaerobic bacterial infection as underlying cause Patient is presenting diplopia, proptosis, redness, and APD, with red/green deficiency, Hx of fever in the past 2 days. [brainscape.com]

  She also noticed diplopia in all gazes. She initially presented to her pediatrician who thought she had a preseptal cellulitis and started her on amoxicillin. [webeye.ophth.uiowa.edu]

  […] thrombosis Diffuse, balloon-like swelling and violet discoloration of upper and lower lids Eye pain Tenderness to touch of lids Mildly engorged conjunctival vessels Proptosis (in "post-septal cellulitis") Reduced eye movements (in "post-septal cellulitis") Diplopia [kellogg.umich.edu]

  Patients presenting with signs and symptoms of eyelid edema, diplopia, reduced visual acuity, abnormal light reflexes, ophthalmoplegia and proptosis need admission ( Figure 10). [intechopen.com]

• Strabismus

  B Adjunct therapy: hyperbaric oxygen therapy may possibly be beneficial Orbital cellulitis infectious inflammatory process involving the orbital tissues posterior to the orbital septum and requires Etiologies include trauma, orbital fracture repair, strabismus [drmansueto.com]

  It has been reported after strabismus surgery, blepharoplasty, radial keratomy and retinal surgery. 1, 2 This is a short case report of orbital cellulitis following peribulbar anaesthesia. [nature.com]

  Surgical procedures, including orbital decompression, dacryocystorhinostomy, eyelid surgery, [3] strabismus surgery, retinal surgery, and intraocular surgery, have been reported as the precipitating cause of orbital cellulitis. [emedicine.medscape.com]

  Ophthalmologic surgery (including retinal surgery, blephaoplasty, strabismus surgery, and radial keratotomy). Orbital trauma. Dental infection. Facial infection. Dacrocystitis. Middle ear infection. Hordeolum. [clinicaladvisor.com]

  The patient may have strabismus and subsequent diplopia due to the restriction of extraocular muscle movement. In severe cases, the patient may have optic neuropathy with a relative afferent pupillary defect. [healio.com]

• Unilateral Proptosis

  Clinically, all patients presented with unilateral proptosis, periorbital edema and tenderness, and restriction of ocular motility. Fever was absent in 39.2% of patients. [joii-journal.springeropen.com]

• Unilateral Ptosis

  Signs include unilateral ptosis, proptosis, visual loss, internal and external ophthalmoplegia (ie, palsy of the pupillary and extraocular muscles), and CN V1 (forehead) anesthesia. [emedicine.medscape.com]

• Dysesthesia

  This is a life-threatening complication that is diagnosed by ptosis, orbital pain, severe loss of visual acuity, prostration, hypoesthesia, dysesthesia, and paresthesia along cranial nerves VI or VII, rapid progression chemosis and limitation of extraocular [sinusitisunderstood.blogspot.com]

• Renal Insufficiency

  Renal Insufficiency. Doses of antibiotics need to be appropriately dosed for patients with renal insufficiency. B. Liver Insufficiency. No change in standard management. C. Systolic and Diastolic Heart Failure. No change in standard management. D. [clinicaladvisor.com]

For workup of orbital infection, radiologic investigations are essential to visualize the lesions, their localization, severity and spread to nearby tissues. Computed tomography (CT) scan of the orbit, sinuses, and frontal lobe is one of the primary modalities for diagnosis. Contrast is commonly used to exclude the presence of artifacts. In pediatric patients, it is important to lower the dose of radiation [7] by choosing magnetic resonance imaging (MRI) over CT scan.

MRI scan is less cost-effective but more specific in investigating the soft tissues, specifically those that are infected. Also, MRI creates the possibility to visualize the spread of the orbital lesion and is better in distinguishing the cavernous sinus [8]. To further increase accuracy rate of the MRI, a contrast enhanced scan (gadolinium-based intravenous contrast) is used, particularly if there is high suspicion of infectious advancement deeper into anatomical structures [9]. T1-weighted imaging typically exposes infiltrations into periorbital fat if they exist. On the other hand, T2-weighted imaging distinguishes infectious lesions that are identified by hyperintense properties [10] [11]. MRI findings also include abscess masses, a presence of inflammation marked by enhanced eyelids and soft tissues of the orbit [11].

Laboratory studies comprise blood glucose level, complete blood count, as well as cerebrospinal fluid (CSF) analysis if meningitis is suspected. In presence of fever, a blood sample for possible leukocytosis must be obtained [10] [6].

• Iron Increased

  0.0 % 2-9: 0.0 % 10-19: 0.0 % 20-29: 0.0 % 30-39: 0.0 % 40-49: 0.0 % 50-59: 0.0 % 60 : 100 % Top conditions involved for these people *: Arteriosclerosis Coronary Artery (thickening and hardening of arteries- coronary artery): 4 people, 100.00% Blood Iron [ehealthme.com]

• Creatinine Increased

  Increased: 3 people, 75.00% * Approximation only. [ehealthme.com]

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