Outcome of treated orbital cellulitis in a tertiary eye care center in the middle East.
OBJECTIVE
To describe risk factors predisposing patients to orbital cellulitis and potential complications in patients treated at a tertiary eye care referral center in the Middle East.


METHODS
Noncomparative, interventional, retrospective case series.


METHODS
Patients diagnosed with orbital cellulitis.


METHODS
A 15-year clinical review of patients with a diagnosis of orbital cellulitis referred to King Khaled Eye Specialist Hospital, an accredited (Joint Council on Accreditation of Healthcare Organizations, Washington, DC) tertiary care center in Riyadh, Saudi Arabia, was performed. Only those patients who had clinical signs and symptoms or radiologic evidence suggestive of orbital cellulitis were included in the study.


METHODS
Patient demographics, factors predisposing to orbital cellulitis, and resulting complications.


RESULTS
A total of 218 patients (136 male, 82 female) fulfilling the diagnostic criteria for orbital cellulitis were identified. The average age of these patients was 25.7 years (range, 1 month-85 years). On imaging studies, there was evidence of inflammatory or infective changes to orbital structures; orbital abscesses were identified in 116 patients (53%). Sinus disease was the most common predisposing cause in 86 patients (39.4%), followed by trauma in 43 patients (19.7%). All patients received systemic antibiotic treatment before the identification of any responsible organisms. Of the 116 patients with orbital abscess, 101 patients (87%) required drainage. The results of cultures in patients in whom an orbital abscess was drained were positive for 91 patients (90%). The most common microorganisms isolated from the drained abscesses were Staphylococci and Streptococci species. Blood cultures were positive in only 4 patients from whom blood was drawn for cultures. Visual acuity improved in 34 eyes (16.1%) and worsened in 13 eyes (6.2%), including 9 (4.3%) eyes that sustained complete loss of vision, which was attributed to the delay in correct diagnosis and timely intervention (average 28 days vs. 9 days in patients with no loss of vision; P<0.05). There were 9 cases of intracranial extension of orbital abscesses that required either extended treatment with systemic antibiotics alone or in combination with neurosurgical intervention. Most patients received oral antibiotics on discharge for varying periods. There were 6 cases (2.7%) of strabismus and 4 cases (1.8%) of ptosis that persisted after treatment and resolution of orbital cellulitis.


CONCLUSIONS
Untreated sinusitis and prior history of orbital trauma were the 2 major causes of orbital cellulitis in patients referred to a tertiary care eye center in the Middle East. Although rare, severe visual loss still remains a serious complication of delayed detection and intervention in most cases of orbital cellulitis.
Chaudhry
Imtiaz A
IA
Oculoplastic and Orbit Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. orbitdr@hotmail.com
Shamsi
Farrukh A
FA
Elzaridi
Elsanusi
E
Al-Rashed
Waleed
W
Al-Amri
Abdulrahman
A
Al-Anezi
Fahad
F
Arat
Yonca O
YO
Holck
David E
DE
D000038:Abscess / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D002481:Cellulitis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods; D015353:Eye Enucleation; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy*; D005260:Female; D006782:Hospitals, Special; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D009885:Ophthalmology; D009916:Orbital Diseases / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012529:Saudi Arabia; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents