Background

Orbit infections are not very common but they are devastating infections that might lead to meningitis, blindness or even death. It is very important for the emergency physician to take accurate and rapid diagnosis and initiate therapy so that the patients does not end up being visually impaired which often occurs when patients do not get the definitive treatment in good time. The fibrous sheet that is peripherally attached around the orbit’s margin is called the orbital septum. It is fused centrally into tarsal plates where it separates the orbital cavity’s contents from the eyelids. Orbital cellulitis is potentially life-threatening. However, it is an uncommon infection that is often characterized by infection of soft tissues that are found behind orbital septum. Preseptal cellulitis is more common but less serious. It is an infection found on the anterior side of the orbital septum. It has been reported that preseptal cellulitis usually progresses to the adverse conditions of orbital cellulitis if untreated. This often occurs in young children.

Epidemiology

It has been found that preseptal cellulitis is more common than orbital cellulitis although the data that relates to exact incidence is scarce. Both orbital and preseptal cellulitis occurs mostly during the winter seasons. This is attributed to the high prevalence of the paranasal sinus infections. The diseases affect male and female alike, and also black, white, Asians, Arabs and he Indians. However, orbital cellulitis affects female children more than the number of male children. It has been discovered that both orbital and preseptal cellulitis occur mostly in children. Orbital cellulitis affects seven to twelve year olds while preseptal cellulitis affects children at younger ages (below ten years). Orbital and preseptal cellulitis both occur after eyebrow piercing in most people. The examinations carried out for preseptal cellulitis show that it is unilateral, there is swelling of eyelids, tenderness, periorbital area and also erythema. The cause might be a mild fever, history of sinusitis or local skin bites or abrasions. There is an intense oedema that makes it hard to open the eye lids. There is also the occurrence of normal or blurred vision. In orbital cellulitis, it has been discovered that it is also unilateral, there is a rapid onset of swelling and also erythema, and there is also a case of diplopia, system malaise and fever. Pain and lid oedema and erythema are characteristics of orbital cellulitis.

Pathophysiology

There subperiosteal fluid collections where some are quite large often accumulate.  These fluid collections are called subperiosteal abscesses. It has however been discovered that many of these abscesses are sterile initially. The complications of orbital cellulitis include; optic neuropathy often caused by high or increased intra-orbital pressure, vision loss often from ischemic retinopathy, ophthalmoplegia (restricted ocular movements) usually caused by inflammation of the soft-tissues, cerebral abscess, meningitis, cavernous thrombosis and lastly the intracranial sequelae usually from the central spread of infection.

It has been discovered that orbital cellulitis often occurs in three situations; direct inoculation of orbit from surgery or trauma; the extension of an infections usually from periorbital structures which are most commonly got from the paranasal sinuses, but they can also be from the globe, the face, and also the lacrimal sac; and a spread from bacteremia which is usually hematogenous. The orbital’s medial wall is often thin and perforated by; numerous nerves, blood vessels and also by other defects for example the Zuckerkandl dehiscences. This combination of foramine for the neurovascular passage, thin bone and the defects that occur naturally in the bone allows communication of the infectious organisms between the subperiorbital space that is located in the orbit’s medial section and the ethmoidal air cells.