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C.V. Hix, J. Sivak–Callcott, M. Hawes, D. Meyer, R.P. Yeatts; Class IV Bacterial Orbital Abscess: Case Series and Literature Review . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4953.
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Purpose: A great deal is known about orbital cellulitis and subperiosteal abscess, but reports on Chandler Class IV bacterial orbital infection are scattered and sparce, making it difficult to look to the literature for help in managing these cases. We undertook this study to add new cases and summarize what is published about these serious infections. Methods: An English language Medline search was performed. A total of 137 articles were analyzed for history, imaging, surgical description, or autopsy/pathology that indicated the presence of Class IV orbital abscess. A call for unreported cases was made to ASOPRS and the Orbit Society. We reviewed each Class IV case for presentation, demographics, etiology, treatment, and outcome. Results: Five unpublished and 90 reported cases were identified. Mean age was 33 years (range 5 days to 72 years); 62% were male; presenting visual acuity ranged from 20/20 to NLP; 83% had an afferent papillary defect; 92% had ophthalmoplegia and proptosis; most common etiologies were sinusitis and dacryocystitis; most frequent causative organism was Staphylococcus aureus. Treatment was varied, but the majority of cases underwent surgical debridement. Outcomes were better with prompt intervention; however, 26% blinded and 10% died. Conclusion: Class IV bacterial orbital abscesses are uncommon, but can lead to blindness, cavernous sinus thrombosis, brain abscess, and death. Management should entail prompt examination, culture, broad spectrum antibiotics (with Staphylococcal coverage), imaging, surgical debridement, and treatment of associated predisposing conditions (e.g. sinusitis, dacryocystitis).
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