Visual outcomes following orbital decompression for orbital infections.

OBJECTIVE: To analyze the visual outcomes and sequelae of endonasal intervention for orbital infections. INTRODUCTION: Orbital infections pose a serious threat to vision in the pediatric population and can result in complications such as blindness, diplopia, intracranial involvement, and death. [1] Orbital decompression by endonasal intervention is a common treatment to address a variety of orbital infections including orbital cellulitis, orbital abscesses, and subperiosteal abscesses. [2] The outcomes of visual sequelae such as loss or limitation of visual acuity, extraocular movements, and increased intraocular pressure following orbital decompression via endonasal intervention have not been sufficiently investigated in the current literature. METHODS: This retrospective cohort study was performed at our tertiary care pediatric hospital using data from 69 patients aged 0-18 years who were admitted between 2008 and 2018. Data was extracted from the electronic medical record system. RESULTS: Following endoscopic sinus surgery, symptoms of orbital infection improved throughout the cohort. Improvement in visual acuity is demonstrated by a statistically significant decrease in the average logMAR value in both the right and left eye (P = 0.002 and P = 0.028 respectively). There was also a significant improvement to normal values postoperatively for patients who initially presented with abnormal tonometry, extraocular movement, and the appearance of eyelids and eyelashes. CONCLUSION: There is no decline or loss of vision with otolaryngology surgical intervention for orbital cellulitis in our cohort. This retrospective chart review demonstrates the efficacy of surgical intervention on overall visual outcomes following endonasal intervention for orbital infections such as orbital cellulitis, orbital abscesses, and subperiosteal abscesses.

Transnasal endoscopic drainage of neonatal orbital abscess.

Neonatal orbital complications are rare and potentially fatal, demanding prompt diagnosis and adequate treatment. A 25-day-old neonate presented with rapidly progressive orbital complications as evidenced by proptosis, chemosis, lid oedema and restricted eye movements, developing within 3 days. There was no significant medical history or risk factors for developing infection. An initial conservative approach with antimicrobial therapy failed to show any resolve. An MRI brain, orbits and paranasal sinuses demonstrated that there were features suggestive of right orbital cellulitis with possibility of abscess formation with right ethmoidal mucoinflammatory disease and mass effect on the optic nerve causing stretching and compression by the surrounding inflammation.The patient was treated successfully with transnasal endoscopic drainage and decompression. Endoscopic access was challenging owing to the restrictive anatomy. Postoperatively, the patient showed improvement, with gradual decrease in proptosis and resolve in eye movements.

Resolución Quirúrgica para Un Caso de Polisinusitis de Origen Odontogénico / Surgical Resolution for A Case of Polysinusitis of Odontogenic Origin

La celulitis orbitaria es una patología grave que está asociada con sinusitis paranasal. Éstas suelen presentar edema periorbitario, dolor, y movimiento extraocular restringido. La mayoría de los casos presentan pronóstico favorable, asociado a terapia antibiótica o drenaje quirúrgico. Las celulitis de origen odontogénico representan 2 a 5 % de todos los casos; se caracterizan por una diseminación del proceso infeccioso desde los ápices de las raíces, infectando al seno maxilar, llegando a la órbita a través de la fisura orbitaria inferior o a través de un defecto en el piso de la órbita. En el presente estudio se reporta el caso de un paciente masculino de 28 años que consulta por aumento de volumen periorbitario izquierdo con 4 días de evolución, posterior a exodoncia de segundo molar superior izquierdo. Al examen extraoral presenta aumento de volumen izquierdo con eritema periorbitario, proptosis ocular ipsilateral con visión conservada, y salida de líquido purulento por fosa nasal izquierda. En los exámenes de laboratorio e imagenológicos se pesquisa compromiso de seno maxilar, etmoidal y esfenoidal, decidiendo su hospitalización y manejo quirúrgico en tres tiempos operatorios, los cuales permiten acceso a pared anterior del seno maxilar y a espacio pterigoideo. Dentro de los diagnósticos de celulitis orbitaria pueden incluir reacciones alérgicas, conjuntivitis o herpes. Se excluyeron los diagnósticos mencionados debido a que no se observaron alteraciones dermocutáneas periorbitarias. Por el contrario, el compromiso unilateral, movimiento ocular alterado y doloroso indica que el cuadro abarcaba espacios profundos. La infección de senos paranasales posterior a una exodoncia es una complicación poco frecuente. Un diagnóstico temprano adecuado disminuye la morbilidad y mortalidad de esta condición. Debemos estar alertas a complicaciones posteriores en procedimientos realizados, tener conocimiento en diagnóstico y manejo de posibles evoluciones tórpidas en pacientes.

Orbital cellulitis is a serious pathology that is associated with paranasal sinusitis. These medical conditions usually present with periorbital edema, pain, and restricted extraocular movement. Most cases have a favorable prognosis, associated with antibiotic therapy or surgical drainage. Cellulitis of odontogenic origin represents 2 to 5 % of all cases. They are characterized by a spread of the infectious process from the apices of the roots, infecting the maxillary sinus, reaching the orbit through the inferior orbital fissure or through a defect in the floor of the orbit. The present study reports the case of a 28-year-old male patient, who consulted for a volume increase in left periorbital volume with 4 days of evolution, after extraction of the upper left second molar. Extraoral examination showed left volume increase with periorbital erythema, ipsilateral ocular proptosis with preserved vision, and discharge of purulent fluid from the left nostril. The laboratory and imaging tests showed compromise of the maxillary, ethmoid and sphenoid sinus deciding on hospitalization and surgical management in three operative times, which allow access to the anterior wall of the maxillary sinus and the pterygoid space. Diagnoses of orbital cellulitis may include allergic reactions, conjunctivitis, or herpes. These diagnoses were excluded because no periorbital dermocutaneous alterations were observed. In contrast, unilateral involvement, impaired eye movement, and pain indicate that the condition involved deep spaces. Paranasal sinus infection after tooth extraction is a rare complication. An early diagnosis adequately decreases the morbidity and mortality of this condition. We must be alert to subsequent complications in procedures performed, have knowledge in diagnosis and management of possible torpid evolutions in patients.

[Orbital cellulitis secondary to odontogenic superior maxillary sinus septum infection: a case report].

A 66-year-old woman presented with recurrent erythema, swelling and pain in her right eye. She had a history of extraction of the right upper second molar 5 months ago with subsequent development of an abscess which was incised and drained 4 months ago. Orbital CT scan revealed the formation of subperiosteal sinus cavity with an abscess in the right maxillary sinus and infraorbital foramen. The diagnosis was orbital honeycombing caused by odontogenic maxillary sinus septum infection. Utilizing the anterior lacrimal recess approach under nasal endoscope,incision and drainage of ocular abscess and debridement and drainage of right orbital abscess plus partial resection of the inner wall of the jaw were performed successfully with maxillary sinus septal drainage and maxillary sinus opening. The patient improved significantly after the operation.

Factors Associated with Surgery and Imaging Characteristics in Severe Orbital Infections.

OBJECTIVES: To evaluate risk factors associated with surgical intervention and subperiosteal/orbital abscess in hospitalized children with severe orbital infections. STUDY DESIGN: We conducted a multicenter cohort study of children 2 months to 18 years hospitalized with periorbital or orbital cellulitis from 2009 to 2018 at 10 hospitals in Canada. Clinical details were extracted, and patients were categorized as undergoing surgical or medical-only management. Primary outcome was surgical intervention and the main secondary outcome was clinically important imaging. Logistic regression was used to identify predictors. RESULTS: Of 1579 patients entered, median age was 5.4 years, 409 (25.9%) had an orbital/subperiosteal abscess, and 189 (12.0%) underwent surgery. In the adjusted analysis, the risk of surgical intervention was associated with older age (age 9 to <14: aOR 3.9, 95% CI 2.3-6.6; and age 14 to ≤18 years: aOR 7.0, 95% CI 3.4-14.1), elevated C-reactive protein >120 mg/L (aOR 2.8, 95% CI 1.3-5.9), elevated white blood cell count of 12-20 000/µL (aOR 1.7, 95% CI 1.1-2.6), proptosis (aOR 2.6, 95% CI 1.7-4.0), and subperiosteal/orbital abscess (aOR 5.3, 95% CI 3.6-7.9). There was no association with antibiotic use before hospital admission, sex, presence of a chronic disease, temperature greater than 38.0°C, and eye swollen shut. Complications were identified in 4.7% of patients, including vision loss (0.6%), intracranial extension (1.6%), and meningitis (0.8%). CONCLUSIONS: In children hospitalized with severe orbital infections, older age, elevated C-reactive protein, elevated white blood cell count, proptosis, and subperiosteal/orbital abscess were predictors of surgical intervention.

Sinogenic polymicrobial anaerobic orbital cellulitis: the importance of source control and broad empirical antibiotics.

A man in his twenties with a history of recurrent sinusitis was urgently referred to the emergency department (ED) by an out-of-hours general practitioner following a 2-day history of increasing right eye pain, redness and swelling after a week of coryzal symptoms. He denied visual impairment and any history of recent dental pain or procedures. Initial assessment in ED noted fever, tachycardia and hypotension. Video consultation with ophthalmologist in the ED identified proptosis, periorbital erythema and chemosis with full eye movement solely affecting the right eye. Visual acuity of 6/6 was confirmed in both eyes. After review by the ear, nose and throat (ENT) team, a diagnosis of sinogenic right orbital cellulitis was made, empirical antibiotics started and care transferred to the ENT team for immediate surgical intervention. 48 hours postoperatively, the patient acutely deteriorated, developing ophthalmoplegia and visual acuity of 6/95 in the right eye. Repeat imaging demonstrated a deteriorating picture and urgent surgery was organised at a neighbouring hospital's specialist ENT unit combined with a change to his antibiotics. On day 4, 1 day following transfer, an anaerobic bacterium, Eggerthia catenaformis, was isolated from blood cultures collected on admission. The patient improved clinically following the second surgery and targeted antimicrobial therapy, eventually being discharged 10 days after initial presentation. In addition to E. catenaformis, the Anaerobic Reference Unit (Cardiff) identified two further anaerobic bacteria, Parvimonas micra and Dialister pneumosintes This paper presents the first documented case of polymicrobial anaerobic orbital cellulitis secondary to acute bacterial sinusitis. Moreover, this case underpins the importance of broad empirical antibiotics coupled with surgical source control to effectively manage a rare but sight-threatening and life-threatening disease.

Complete manuscript title: Neurological complications from sinugenic orbital cellulitis.

INTRODUCTION: This study was undertaken with an aim to identify any common factors or trends among patients of orbital cellulitis that developed neurological complications. METHODS: A 24-month retrospective review of patients was undertaken to include those showing clinical deterioration and neurological complications on radiological imaging, after being treated for orbital cellulitis at Manchester Royal Eye Hospital. The study specifically looked at the site of orbital collection, sinus involvement, types of neurological complications and whether these were detected at initial presentation, surgical input and microbiology findings. RESULTS: Nine patients (9/26) developed associated neurological complications during the study period. (February 2018 and January 2020) This included subdural empyema in six patients; leptomeningeal enhancement in two and septic emboli in one patient. All the patients had associated significant pan-sinusitis at initial presentation. Neurological complications were detected in three patients at the time of admission and after clinical deterioration and further investigations in the rest. CONCLUSION: A superior orbital abscess and Streptococcus mileri infection had higher risk of neurological complications. It is worth debating whether patients with chronic sinusitis who develop orbital cellulitis need earlier surgical input rather than a conservative treatment. Patients who fail to improve clinically need to be re-imaged to look for possible neurological complications.

Celulite orbital por rinossinusite maxilar, etmoidal e frontal em paciente adulto: relato de caso / Orbital cellulitis by maxillary, etmoidal and frontal rhinosinusitis in an adult patient: case report

A celulite orbital é uma complicação incomum após quadro de rinossinusite. O objetivo do presente trabalho é relatar um caso de um paciente do sexo masculino, adulto-jovem, 22 anos de idade, que compareceu ao serviço de emergência apresentando edema periorbitário direito, proptose, oftalmoplegia, cefaléia, obstrução nasal e febre. O diagnóstico foi realizado por uma equipe multidisciplinar. A tomografia computadorizada pré-operatória apresentou edema difuso em região periorbitária direita, velamento dos seios: maxilar, esfenoidal e frontal ipsilateral. O paciente foi internado para abordagem cirúrgica e antibioticoterapia. A celulite orbitária associada a rinossinusite é uma complicação rara, sendo comum em crianças, que necessita de um diagnóstico e abordagem multidisciplinar e precoce para evitar extensões cranianas... (AU)

Orbital cellulitis is an uncommon complication after rhinosinusitis. The aim of the present study is to report a case of a 22-year-old male patient, young, 22 years old, who attended the emergency department with right periorbital edema, proptosis, ophthalmoplegia, headache, nasal obstruction and fever. The diagnosis was made by a multidisciplinary team. Preoperative computed tomography showed diffuse edema in the right periorbital region, veiling of the sinuses: maxillary, sphenoidal and ipsilateral frontal. The patient was admitted for surgical approach and antibiotic therapy. Orbital cellulitis associated with rhinosinusitis is a rare complication, common in children, which requires a multidisciplinary and early diagnosis and approach to avoid cranial extensions... (AU)

Predictors of surgical management for paediatric orbital subperiosteal abscesses.

PURPOSE OF REVIEW: Many paediatric orbital subperiosteal abscesses (SPA) are effectively managed conservatively with systemic antibiotics, but surgical drainage is required in some patients. This review aims to summarize the current literature to determine predictors of surgical intervention. RECENT FINDINGS: Nearly all the data regarding this topic come from analysis of retrospective case series. There is consensus that large volume SPAs require surgical drainage; however, the cutoff for volume differs between studies. Proptosis more than 5 mm, superior location of SPA and patient age more than 9 years are also all factors that may predispose towards surgical treatment. SUMMARY: A conservative approach may be trialled in younger patients with medial, smaller volume SPAs. Larger volume SPA, presence of proptosis, superior location of SPA and patient age more than 9 years should lower the threshold for considering surgical intervention. Given that many studies have been retrospective, future studies should be prospective and specifically aim to determine a cutoff for SPA volume.

Odontogenic orbital inflammation.

Objective: This study aimed to determine the most frequent clinical aspects in patients with odontogenic orbital inflammation, the computed tomography (CT) aspect, and the most appropriate treatment. Material and Methods: This is a retrospective case-series study conducted on 3 patients with ages between 16 and 55 years old, in the Ophthalmology and Oro-Maxillo-Facial Clinics of "Sf. Spiridon" Emergency Hospital, Iași, Romania. The following investigations were performed in all selected cases: visual acuity (VA), ocular motility examination, anterior segment examination at slit-lamp, fundus examination, intraoral clinical examination, sinus and orbital involvement on CT scan, pathogens involved. Results: All three patients presented swelling of the genic and periorbital regions, conjunctival chemosis, hyperemia of the conjunctiva, proptosis, pain, decreased vision and extraocular movement restriction. The CT examination identified orbital and periorbital cellulitis and ethmoidal expanded maxillary sinusitis or pansinusitis. Dental extraction, transalveolar drainage and orbital decompression were performed in all three cases. The evolution was favorable with remission of proptosis, edema of the genic and periorbital regions and conjunctival chemosis. Visual acuity remained poor in one case due to total optic nerve atrophy. Conclusions: Our study had a small number of patients, but the data was pertinent to ophthalmologists and maxillofacial surgeons who need to be aware of typical clinical features and the most common etiologies. Late treatment of dental infections can lead to severe ocular manifestations such as orbital cellulitis. Odontogenic orbital inflammation management involves a long-term and multidisciplinary approach. Abbreviations: CT = computed tomography, VA = visual acuity, CBCT = cone beam computed tomography, TED = thyroid eye disease, MRI = magnetic resonance imaging, OOC = odontogenic orbital cellulitis, RAPD = relative afferent pupillary defect.

Orbital complications of infected mucocele in the paranasal sinuses.

OBJECTIVE: Infected mucocele of the paranasal sinuses can induce orbital infection, including orbital subperiosteal abscess, which may lead to life-threatening intracranial complications. Effective diagnosis is important, and treatment should be aggressive. This paper presents our experiences in endoscopic surgical management of orbital complications secondary to infected paranasal sinus mucoceles. METHODS: From our retrospective review of the medical charts for 82 patients with 92 sides diagnosed with paranasal sinus mucoceles, we present 7 sides in 7 adult patients with orbital complications secondary to infected mucoceles. The collected data include the suggested etiology, side of sinus involvement, localization of abscess in the orbit, orbital wall bone defects caused by mucocele compression, ophthalmic symptoms, duration between symptom onset and initial visit, operation date, type of surgery performed, and follow-up. RESULTS: The mucocele was located in the ethmoid-frontal region in 9.8% of the sides (9/92), in the frontal sinus in 7.6% (7/92), in the ethmoidal sinus in 9.8% (9/92), in the maxillary sinus in 67.4% (62/92), in the maxillary-ethmoidal sinus in 3.3% (3/92), and in the sphenoid sinus in 2.2% (2/92). The patients with ethmoid-frontal mucoceles had a significantly higher incidence of orbital complications (6/9) as compared with the other sub-types of mucoceles (frontal, 0/7; ethmoidal, 0/9; maxillary, 1/62; maxillary-ethmoidal, 0/3; sphenoid, 0/2). Chandler's classification showed Type I in one, Type II in three, and Type III in three. Sinus involvement was observed at the ethmoid-frontal sinuses in six cases and the maxillary sinus in one case. All seven cases had a partial defect of the orbital wall bone (lamina papyracea, or inferior orbital wall bone) by mucocele compression, and the patients underwent endoscopic marsupialization. For the cases with subperiosteal abscess, the lamina papyracea was also removed partially for draining the abscess. In all cases, symptoms were resolved without any recurrence of the mucocele. CONCLUSIONS: Infected ethmoid-frontal mucoceles with a defect of the lamina papyracea tend to induce orbital infection, so prompt surgery for the infected mucoceles should be considered early even with Types I and II, before visual acuity is impaired, because surgery is the only curative treatment for the mucoceles.

Incidence and extent of sinus procedures in treatment of pediatric orbital cellulitis.

INTRODUCTION: It is unknown the optimal extent of sinus surgery in pediatric patients with orbital cellulitis. Our aim was to determine the nationwide incidence of sinus procedures used to treat pediatric orbital cellulitis. Additionally, we sought to identify patient-factors that influence a multi-procedural approach. METHODS: Cross-sectional analysis of 15,260 cases of primary pediatric orbital cellulitis identified in the Kids' Inpatient Database (KID) from January 1, 2003 to December 31, 2012. Cases were included if they contained a primary diagnosis code of orbital cellulitis. Frequency of sinus procedures in relation to pediatric age cohort were noted (≤8 years versus 9-20 years). Comorbidities, cost, and length-of-stay were compared between age cohorts. Multivariate models investigated patient-factors associated with multiple sinus procedures and patient-factors that affected hospital costs and length-of-stay. RESULTS: Children ≤8 years of age constituted 67% of cases (n = 10,290). 1103 cases (7.2%) were treated with at least one defined sinus procedure; and, 712 of these cases documented more than one sinus procedure. The younger cohort (≤8 years) exhibited fewer sinus procedures and a lower rate of reoperation (4.6% vs 12.8%, p < .001; 5.1% vs 7.7%, p < .001, respectively). Presence of cellulitis/abscess of the face was the strongest predictor of multiple sinus procedures (OR = 1.982, p = .033). Patients with acute sinusitis and those >8 years had similarly increased odds of a multi-procedural approach (OR = 1.333, p = .049; OR = 1.367, p = .032, respectively). Multivariate analysis of cost and length-of-stay found that patients >8 years incurred 14% longer hospital stays and an increase in costs of 9% compared to younger patients (p = .001, p = .039; respectively). The secondary diagnosis with the largest effect on length-of-stay and cost was an intracranical abscess (OR = 2.352, p < .001; OR = 2.752, p < .001; respectively). CONCLUSION: In a nationwide population of pediatric patients with primary orbital cellulitis there was an incidence of sinus surgery in 7.2% of cases - with patients over 8 years having a 2.8-fold increase compared to younger patients. Additionally, nearly two-thirds of patients treated with sinus surgery had multiple sinus procedures. The high incidence of multiple sinus procedures suggests that further prospective studies are needed to elucidate the extent of drainage associated with the best patient outcomes.

Invasive Rhino-Orbito-Cerebral Mucormycosis in Pediatric Patient with Acute Leukemia.

BACKGROUND: Invasive fungal infections are a life-threatening complication of cancer treatments, especially in hemato-oncological patients. Mucormycosis is the third leading cause of invasive fungal infections after Aspergillus and Candida infections. The first clinical symptoms are usually non-specific, which can lead to a late diagnosis and delayed therapy. PURPOSE: The objective of this report is to summarize data in the literature about mucormycosis and to present a case report of a patient with acute lymphoblastic leukemia, who developed this infection at our center. Risk factors for the development of mucormycosis, clinical symptoms, radiology, laboratory results, and outcome were retrospectively evaluated. CASE: We describe a 6-years-old female patient with acute lymphoblastic leukemia. During the induction phase of therapy, the patient developed febrile neutropenia and did not respond to therapy with a combination of antibiotics and supportive treatment. Pansinusitis and orbitocellulitis developed. Examination of the biological material revealed that the etiological agent was a Rhizopus sp. The patient was treated with a combination of antimycotic drugs, but the infection disseminated to the central nervous system. She underwent radical surgical resection of the affected tissue. At this time, she is still under treatment with antimycotic and oncology agents, but is in remission of the main diagnosis and in good clinical condition. CONCLUSION: Mucormycosis is an invasive fungal infection with high morbidity and mortality. Early diagnosis and initiation of effective therapy using a combination of amphotericin B administration and surgery are necessary to obtain a favorable outcome. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

Enucleación bilateral por panoftalmitis endógena polimicrobiana fulminante / Bilateral enucleation due to multi-bacterial fulminant endogenous panophthalmitis

Mujer de 62 años con disminución de la agudeza visual bilateral rápidamente progresiva y panuveítis con celulitis orbitaria, asociadas a mal estado general, emesis y fiebre. Se diagnosticó septicemia por Klebsiella pneumoniae y panoftalmitis endógena bilateral. La afectación ocular progresó rápidamente a escleroqueratitis y perforación en ambos ojos, pese a recibir manejo antibiótico sistémico de amplio espectro. Finalmente, la paciente requirió enucleación bilateral. Los cultivos microbiológicos de las piezas quirúrgicas identificaron Klebsiella pneumoniae y Candida magnoliae. Según nuestro conocimiento, es el tercer caso publicado que haya requerido enucleación o evisceración bilateral por panoftalmitis endógena y el primer caso de infección ocular endógena causada por Candida magnoliae

The case is presented of a 62 year-old woman with a rapid, progressive bilateral decrease in visual acuity and panuveitis with orbital cellulitis. She was also in poor general condition, with emesis and fever. Septicaemia due to Klebsiella pneumoniae and bilateral endogenous panophthalmitis were diagnosed. The ocular infection quickly progressed to sclerokeratitis and bilateral perforation despite broad spectrum systemic antibiotic management, and eventually the patient required bilateral enucleation. Microbiological cultures of the surgical pieces identified Klebsiella pneumoniae and Candida magnoliae. To our knowledge, this is the third published case that required bilateral enucleation or evisceration due to endogenous panophthalmitis, and the first case of endogenous ocular infection caused by Candida magnoliae

Trend of surgery for orbital cellulitis: An analysis of state inpatient databases.

OBJECTIVES/HYPOTHESIS: To evaluate the trend and factors associated with surgical management of orbital cellulitis. STUDY DESIGN: Retrospective database study. METHODS: Study using the State Inpatient Databases (SIDs) from 2008 to 2015. Patients with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code for orbital cellulitis were identified in the SIDs for the following states: Arkansas, Florida, Iowa, Maryland, Nebraska, New York, and Wisconsin. Surgery was defined as an ICD-9-CM procedure code for orbitotomy and/or functional endoscopic sinus surgery. The trend of surgery over time was evaluated using the Cochran-Armitage test. Multivariable logistic regression models were used to identify patient- and hospital-level factors associated with surgery. RESULTS: From 2008 to 2013, the number of hospitalizations for orbital cellulitis ranged from 1,349 to 1,574, but declined to 865 in 2014. From 2008 to 2015, the number of surgeries ranged from 103 to 154. For children (n = 3,041), age, ophthalmologic comorbidity, and conjunctival edema were significantly associated with surgery, whereas for adults (n = 7,961), male gender, private insurance, optic neuritis, and cranial nerves III/VI/VI palsy were associated with surgery. CONCLUSIONS: Although the number of inpatient hospitalizations for orbital cellulitis has markedly declined, the number of surgeries for orbital cellulitis has remained fairly stable, leading to an observed higher proportion of hospitalized patients undergoing surgery. Future directions include extending the time frame to the present day to assess current rates of hospitalization and surgery. Knowledge of surgical trends and patient- and hospital-level characteristics associated with surgery may help improve management guidelines for and understanding of this vision-threatening disease. LEVEL OF EVIDENCE: NA Laryngoscope, 130:567-574, 2020.

Bilateral enucleation due to multi-bacterial fulminant endogenous panophthalmitis. / Enucleación bilateral por panoftalmitis endógena polimicrobiana fulminante.

The case is presented of a 62 year-old woman with a rapid, progressive bilateral decrease in visual acuity and panuveitis with orbital cellulitis. She was also in poor general condition, with emesis and fever. Septicaemia due to Klebsiella pneumoniae and bilateral endogenous panophthalmitis were diagnosed. The ocular infection quickly progressed to sclerokeratitis and bilateral perforation despite broad spectrum systemic antibiotic management, and eventually the patient required bilateral enucleation. Microbiological cultures of the surgical pieces identified Klebsiella pneumoniae and Candida magnoliae. To our knowledge, this is the third published case that required bilateral enucleation or evisceration due to endogenous panophthalmitis, and the first case of endogenous ocular infection caused by Candida magnoliae.

Complicación orbitaria recurrente por rinosinusitis. Reporte de un caso / Recurrent orbital complication by rhinosinusitis. A case report

El compromiso orbitario es la complicación más frecuente de la rinosinusitis aguda en pediatría, y el etmoides es el seno más afectado. La recurrencia es infrecuente. Existen solo tres casos publicados en la literatura. Una anomalía anatómica del proceso unciforme o un mucocele podrían ser factores predisponentes, que pueden obstruir el drenaje normal de los senos junto con la presencia de etmoiditis.La tomografía computada y la resonancia magnética orientan el diagnóstico. El tratamiento quirúrgico está indicado ante la falta de respuesta al tratamiento instaurado luego de 48 horas o disminución de la agudeza visual o recurrencias sin patología tumoral de base.Se presenta a un paciente de 4 años de edad que consultó por un cuadro compatible con etmoiditis complicada recurrente. Presentó celulitis preseptal en seis oportunidades y un episodio de absceso subperióstico, desde los 3 meses de edad. Evolucionó favorablemente luego de la operación quirúrgica.

Orbital infection is the most frequent complication of ethmoiditis. Recurrent periorbital cellulitis is a very rare complication of rhinosinusitis with only three reports in the literature describing this pathological process.This complication can be favored by an anatomical abnormality of the uncinate process or mucocele obstructing the normal drainage pathway, in addition to ethmoidal sinusitis.Computed tomography and magnetic resonance guide the diagnosis. The treatment is based on antibiotics, corticosteroids and local decongestants. Surgical treatment is indicated in the absence of response to treatment established after 48 hours or decrease in visual acuity or recurrent orbital complications without underlying tumor pathology. In this report, we present a case of orbital complication of rhinosinusitis in a 4 year-old-child with six episodes of unilateral periorbital cellulitis and one episode of subperiosteal orbital abscess since the age of 3 months. There was a complete resolution with no recurrence after the surgical intervention

[Recurrent orbital complication by rhinosinusitis. A case report]. / Complicación orbitaria recurrente por rinosinusitis. Reporte de un caso.

Orbital infection is the most frequent complication of ethmoiditis. Recurrent periorbital cellulitis is a very rare complication of rhinosinusitis with only three reports in the literature describing this pathological process. This complication can be favored by an anatomical abnormality of the uncinate process or mucocele obstructing the normal drainage pathway, in addition to ethmoidal sinusitis. Computed tomography and magnetic resonance guide the diagnosis. The treatment is based on antibiotics, corticosteroids and local decongestants. Surgical treatment is indicated in the absence of response to treatment established after 48 hours or decrease in visual acuity or recurrent orbital complications without underlying tumor pathology. In this report, we present a case of orbital complication of rhinosinusitis in a 4 year-old-child with six episodes of unilateral periorbital cellulitis and one episode of subperiosteal orbital abscess since the age of 3 months. There was a complete resolution with no recurrence after the surgical intervention.

El compromiso orbitario es la complicación más frecuente de la rinosinusitis aguda en pediatría, y el etmoides es el seno más afectado. La recurrencia es infrecuente. Existen solo tres casos publicados en la literatura. Una anomalía anatómica del proceso unciforme o un mucocele podrían ser factores predisponentes, que pueden obstruir el drenaje normal de los senos junto con la presencia de etmoiditis. La tomografía computada y la resonancia magnética orientan el diagnóstico. El tratamiento quirúrgico está indicado ante la falta de respuesta al tratamiento instaurado luego de 48 horas o disminución de la agudeza visual o recurrencias sin patología tumoral de base. Se presenta a un paciente de 4 años de edad que consultó por un cuadro compatible con etmoiditis complicada recurrente. Presentó celulitis preseptal en seis oportunidades y un episodio de absceso subperióstico, desde los 3 meses de edad. Evolucionó favorablemente luego de la operación quirúrgica.