Factors Predisposing to Visual Loss in Orbital Cellulitis

Abstract

Purpose: : Orbital cellulites can be a potentially vision threatening disease if not treated on a timely basis. We describe incidence and risk factors for visual loss due to orbital cellulitis.

Methods: : A 15–year review of patients with orbital cellulitis at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia was performed and incidence of orbital cellulitis with associated visual loss was studied. Only those patients who had sign and symptoms (such as decreased vision, proptosis, restrictive motility), suggestive of orbital cellulitis were included in the study. Risk factors associated with development of orbital cellulitis such as sinusitis, trauma or endophthalmitis were analyzed and the causative organisms in patients where abscess drainage performed were noted.

Results: : One–hundred and seventy–five patients who developed orbital cellulitis and admitted to the hospital for treatment were identified. Most common cause of orbital cellulitis was preexisting sinusitis or a history of trauma. Orbital computed tomography was most helpful in the diagnosis of associated orbital abscess. These patients were treated with systemic antibiotics and some were subjected to surgical abscess drainage. Microbial culture results were available from 84 patients. The cultures were positive in 77 (91.6%) cases, with an average of 1.5 microorganisms (range 1 to 4). Staphylococcus species were the most frequently recovered organisms, followed by Streptococcus species. Over a mean follow–up period of 20.1 months (range 1 week to 12 years), 11 patients remained with no light perception vision. Majority of the patients who lost vision had signs and symptoms of orbital cellulitis for more than 15–days prior to appropriate treatment.

Conclusions: : Orbital cellulitis may be associated with untreated sinusitis or history of orbital trauma. Although rare, severe visual loss is a serious complication of untreated orbital cellulitis. Early detection and treatment may prevent serious visual loss.

Keywords: inflammation • orbit • clinical (human) or epidemiologic studies: risk factor assessment