Orbital Infection: A Case Study

Introduction
Orbital cellulitis is frequently used to represent a broad spectrum of orbital infections. In 1970 Chandler created a classification system of the various stages of infection, based on severity, to separate this spectrum in five groups: I) pre-septal cellulitis (inflammatory edema); II) Orbital Cellulitis; III) Orbital Subperiosteal Abscess; IV) Orbital Abscess; V) Cavernous Sinus Thrombosis.1,2
The incidence of Orbital Abscess in pediatric population is 15% of the orbital infections, being acute sinusitis of the ethmoid-maxillary complex the most frequent cause of this complication.3
The most frequently isolated bacterial agents are Streptococcus (viridans,pyogenes and epidermidis), Staphylococcus (aureus and coagulase-negative)

Although it may be confirmed by orbital CT scan, it still remains necessary to clinically evaluate the severity of the infection by clinical signs and symptoms.4
It is important to differentiate pre-septal cellulitis from orbital involvement since management is based on the severity of infection, and therapeutic delay may result in blindness in 10% of Orbital Abscess patients.3. Treatment usually includes IV antibiotics, nasal decongestants and surgical drainage if necessary. If inadequately treated, orbital cellulitis may progress to intracranial complications, blindness and even

However, we did not find any of the following factors to be an indicator of failure of antibiotic therapy: age, history of recurrent sinusitis, allergy, asthma or anatomic pathology.
Orbital and/or intracranial sequelae are the most dangerous complications of sinusitis,10-11 with Orbital Abscess representing the most common orbital complication. While the exact incidence of these complications is unknown, they may represent between 1 and 3% of sinus infections, occurring more commonly in children than in adults.12-14
The ethmoid sinuses are most commonly involved in orbital complications of sinusitis.15-16 Ipsilateral pansinusitis on CT scan was the most common diagnostic finding in our series. Weber and Mikulis17 reported that 84% of their children with orbital infections had ethmoid and maxillary sinusitis. However, when such complications occur, the cardinal question is when surgical intervention is indicated. Most authors recommend close clinical monitoring of such orbital signs as proptosis, gaze restriction and visual acuity as the best criteria for deciding upon surgical treatment.1,3,6,12,18,19-20 Antibiotic therapy was successful in 7 of 12 children (58%) in our series. This experience is comparable to that of Soulière et al.,21 who reported a success rate of 50% with various combinations of intravenous antibiotic therapy which included chloramphenicol