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ORBITAL INFECTION
The lamina papyracea of the ethmoid bone forms a large part of the medial wall of the orbit. The orbit, therefore, is
separated from the ethmoid sinuses by the paper-thin and often dehiscent lamina. Because of the weakness of this
barrier, the spread of infection to the orbit is the most common complication of acute sinusitis. In addition, the
ophthalmic venous system is devoid of valves and communicates with the ethmoid veins, providing a path for
infection to enter the orbit. Infection of the orbital structures usually follows a stepwise sequence as described in
Table 143. Inflammatory edema of the lid may be treated in an outpatient setting with oral antibiotics, provided that
close follow-up can be achieved. Orbital cellulitis usually responds to intravenous antibiotics, whereas subperiosteal
and orbital abscesses require operative drainage and drainage of the offending sinus. Cavernous sinus thrombosis is
truly life threatening and is associated with a poor prognosis even with aggressive medical and surgical management.
The incidence of all orbital complications is higher in the pediatric population than in adults.
Lid Edema
No limitation of extraocular movements and vision is normal.
Infection is anterior to the orbital septum.
Orbital Cellulitis
Infection of the soft tissue posterior to the orbital septum.
Subperiosteal Abscess
Pus collection beneath the periosteum of the lamina papyracea.
Orbital Abscess
Pus collection in the orbit.
Associated with limitation of extraocular movements, exophthalmos, and visual changes.
Cavernous Sinus Thrombosis
Bilateral eve involvement, meningeal signs, and other intra-
Fig. 38.2 Mucocele of frontal sinus. Note swelling above the medial canthus of left eye (a rrow).
Tabe
l 38.1 Complications of pa ranasal sinus infection
A. Local
(i) Mucocele/Mucopyocele
(i i) Mucous retention cyst
(iii) Osteomyel i tis
- Frontal bone(more common)
- Maxil la
B. Orbital
(i) Preseptol inflammatory oedema of l ids
(ii) Subperiosteal abscess
(iii) Orbital cell u lit is
(iv) Orbital abscess
(v) Superior orbital fissure syndrome
(vi) Orbi tal apex syndrome