Orbital cellulitis: pathophysiology Orbital cellulitis usually occurs as a result of: Extension of an infection from the periorbital structures

(usually the paranasal sinuses, especially ethmoid sinusitis) and also from the face, the globe, the lacrimal sac and dental infection (via an intermediary maxillary sinusitis). Occasionally, it may occur as an extension of preseptal cellulitis, particularly in young children in whom the orbital septum is not fully developed.[1 !irect inoculation of the orbit from trauma (accidental or surgical " including orbital, lacrimal, strabismus and vitreo"retinal surgery). #ost" traumatic orbital cellulitis tends to develop within $% hours of the in&ury. 'aematogenous spread from distant bacteraemia. The pathogens most commonly involved are the aerobic, non-spore-forming bacteria -Streptococcus pneumoniae, Staphylococcus aureus, Streptococcus pyogenes andHaemophilus influenzae (the latter mainly found in children).[% (ucormycosis associated with patients who have diabetic ketoacidosis or immunosuppression is also described.[) This very rare and rapidly spreading infection caused by fungi, is aggressive and often fatal. [* There has recently been an emergence of (eticillin"resistant S. aureus ((+,-) in the organisms isolated this is rare but the development is worrying.[. Orbital cellulitis may be complicated by spread to ad!acent structures and to the central nervous system.

Orbital cellulitis: ,udden onset of unilateral swelling of con&unctiva and lids. #roptosis (bulging of the eye). #ain with movement of the eye, restriction of eye movements. /lurred vision, reduced visual acuity, diplopia. #upil reactions may be abnormal " relative afferent pupillary defect (+-#!)0 see the separate article on Examination of the Eye. 1ever, severe malaise. "nvestigations

!iagnosis is usually made based on the clinical findings and investigations are aimed at identifying the root cause of the infection " particularly in the case of orbital cellulitis. 2nvestigations are carried out in the hospital setting.

1/3 fre4uently shows a leu5ocytosis (61. 7189) but blood cultures are fre4uently negative in adults. :hey cannot be counted on to differentiate between preseptal and orbital cellulitis. -ny discharge from s5in brea5s should be swabbed and sent to microbiology. :hroat swabs and samples of nasal secretions may also help diagnosis. 3: of the sinuses as well as the orbit ; brain< 3: is usually indicated only for children (unless the child is very well and the episode is mild) or if orbital cellulitis is suspected in an adult. if an intracranial abscess is suspected, 3: is the gold standard imaging modality, carried out to identify any subperiosteal abscesses, paranasal sinusitis or cavernous sinus thrombosis (all needing multi"speciality input). 2t is also valuable in assessing trauma where there may be concerns about a retained orbital or intraocular foreign body. (+2 may complement the 3: in diagnosing a cavernous sinus thrombosis. 2f cerebral or meningeal signs develop, the patient may need a lumbar puncture. 'owever a lumbar puncture is contra"indicated for suspected orbital cellulitis until a 3: scan has ruled out raised intracranial pressure.[11

Orbital cellulitis 'ospital admission under the &oint care of the ophthalmologists and the E=: surgeons is mandatory.[% 2ntravenous antibiotics are used (eg, cefotaxime and flucloxacillin) in addition to metronida>ole in patients over 18 years old with chronic sinonasal disease.[) 3lindamycin plus a 4uinolone such as ciprofloxacin are used where there is penicillin sensitivity. ?ancomycin is also an alternative. Optic nerve function is monitored every four hours (pupillary reactions, visual acuity, colour vision and light brightness appreciation). :reatment may be modified according to microbiology results and lasts for $"18 days. ,urgery is indicated where there is 3: evidence of an orbital collection, where there is no response to antibiotic treatment, where visual acuity decreases and where there is an atypical picture which may warrant a diagnostic biopsy. ,urgery often concurrently warrants drainage of infected sinuses.[*

3omplication Orbital cellulitis[4] Ocular< exposure 5eratopathy (which can lead to visual loss through permanent damage to the cornea), raised intraocular pressure, central retinal artery or vein occlusion, endophthalmitis, optic neuropathy. Orbital abscess< more often associated with post"traumatic orbital cellulitis. /lindness can occur through direct extension of the infection to the optic nerve. Subperiosteal abscess< usually located along the medial orbital wall. :his may progress intracranially. Intracranial (rare)< meningitis, brain abscess, cavernous sinus thrombosis. #rognosis Orbital cellulitis #arly recognition and appropriate treatment should carry a good prognosis, particularly in the absence of complications. $owever immunosuppressed individuals are more susceptible to complications and fungal cellulitis can be associated with a high rate of mortality. Orbital Cellulitis

What is it? Orbital cellulitis is a bacterial infection of the periocular tissues. Cellulitis restricted to the soft tissues anterior to the orbital septum (a connective tissue curtain that divides the anterior third from the posterior two thirds of the orbit) is called "pre-septal cellulitis." It is much less serious than infection that extends behind the orbital septum called "post-septal cellulitis."

!he infection usuall" starts in the paranasal sinuses especiall" the ethmoid. It is especiall" common in children. Orbital cellulitis is rare in adults except amon# the immunocompromised $diabetes mellitus chronic immunosuppressive a#ents or irradiation. In these patients the bi# dan#er is fun#al infection$mucorm"cosis or asper#illosis. %oth are life-threatenin# fun#al infections that re&uire prompt mana#ement. 'ow does it present? Orbital cellulitis presents with periocular pain violaceous swellin# of upper and lower lids and mild diffuse con(unctival h"peremia. )ever and upper respirator" infection s"mptoms ma" be present in children. !he e"elids and #lobe are tender to the touch. If the infection extends posterior to the orbital septum there will be reduced ocular movement and proptosis. *isual loss is rare. In adults fun#al orbital infection ori#inates more posteriorl" in the orbit and ma" show minimal swellin#. +tosis reduced e"e movement and vision loss are more common. ,ela"ed treatment can lead to blindness and intracranial spread of infection with menin#itis stro-e and death. What to do? Order sino-orbital ima#in# studies to rule out sinusitis orbital subperiosteal abscess or tumor. !reat with intravenous antibiotics. .ubperiosteal abscess ma" re&uire sur#ical draina#e. /ac- of improvement in 01 to 12 hours si#nals either an incorrect dia#nosis or ineffective antibacterial a#ents. 3lwa"s thin- of fun#al infections in immunocompromised hosts4 Orbital cellulitis is an acute infection of the tissues immediately surrounding the eye, including the eyelids, eyebrow, and cheek.

%#&' ( )#*T+,#' For a Teenage Boy, a Basketball and a Bug Spell Trouble ,#)#,#%-# ),O. *./.*... 0ack to TopCauses Orbital cellulitis is a dangerous infection with potentially serious complications. Bacteria from a sinus infection (often Haemophilus influenzae)usually cause this condition in children. Orbital cellulitis due to this bacteria used to be much more

common in young children up to age 6 !. "owe#er, such infection is now rare because of the "iB ("aemophilus influen$ae B% #accine. The bacteria Staphylococcus aureus , Streptococcus pneumoniae , and beta hemolytic streptococci may also cause orbital cellulitis. Orbital cellulitis infections in children may get worse #ery &uickly and can lead to blindness. 'mmediate medical attention is needed. 0ack to TopSymptoms Symptoms of orbital cellulitis may include(

)ainful swelling of upper and lower eyelid, and possibly the eyebrow and cheek Bulging eyes *ecreased #ision +ye pain, especially when mo#ing the eye Fe#er, generally ,-. degrees F or higher /eneral ill feeling )ainful or difficult eye mo#ements Shiny, red or purple eyelid 0ack to TopExams and Tests Tests commonly include(

0B0 (complete blood count% Blood culture Spinal tap in e1tremely sick children Other tests may include( 2 ray of the sinuses and surrounding area 0T scan or 34' of the sinuses and orbit 0ulture of eye and nose drainage Throat culture 0ack to TopTreatment The patient usually needs to stay in the hospital. Treatment includes antibiotics gi#en through a #ein. Surgery may be needed to drain the abscess, or relie#e pressure in the orbital space around and behind the eye. 5n orbital cellulitis infection can get worse #ery &uickly. The patient must be carefully checked e#ery few hours. 0ack to TopOutlook (Prognosis) 6ith prompt treatment, the person can make a complete reco#ery. 0ack to TopPossible Complications

0a#ernous sinus thrombosis

"earing loss Septicemia or blood infection 3eningitis Optic ner#e damage and loss of #ision 0ack to TopWhen to Contact a edical Pro!essional

Orbital cellulitis is an emergency that re&uires immediate treatment. 0all your health care pro#ider if there are signs of eyelid swelling, especially with a fe#er. 0ack to TopPre"ention 4ecei#ing the "iB #accine according to recommended schedules generally will pre#ent most haemophilus infections in children. 7oung children in the same household who ha#e been e1posed to this bacteria may recei#e antibiotics to pre#ent getting sick. )roper detection and early treatment of sinus, dental, or other infections may pre#ent the spread of infection to the eyes.

#$T%O&'CT#O$ Orbital cellulitis is a relati#ely uncommon infecti#e process in#ol#ing ocular adne1al structures posterior to the orbital septum., 'nflammation anterior to the orbital septum or preseptal cellulitis is common in young children. 't rarely in#ol#es postseptal anatomy, and physical e1amination re#eals eyelid edema in the absence of orbital signs such as ga$e restriction and proptosis.. Orbital cellulitis is a condition that rarely causes complete loss of #ision if treated in a timely fashion. 5 history of upper respiratory tract infection prior to the onset is #ery common especially in children. For simplification, 0handler et al.8has classified the disease into fi#e categories and emphasi$ed the possibility of fatality due to ca#ernous sinus thrombosis and intracranial abscess. *espite ad#ances in antimicrobial therapy and surgical methods, intracranial abscess remains a challenging problem and the mortality rate can be as high as 9-:.9 'n the past, orbital cellulitis has been associated with a number of serious complications including loss of #isual acuity, ca#ernous sinus thrombosis, meningitis, frontal abscess and osteomyelitis, and e#en death.,,; Since the ad#ent of effecti#e antibiotic treatment, these serious complications ha#e become much less fre&uent. )rior to the a#ailability of antibiotics, blindness was a relati#ely common complication of orbital cellulitis, reported in appro1imately .-: of cases.6 0ase reports of blindness following bacterial orbital cellulitis in the postantibiotic era are rare. For e1ample, 0onnel et al.,!reported a case of a 6< year old male who presented with fulminant onset of proptosis, significant ophthalmoplegia and no light perception. *espite emergent

drainage of an orbital abscess and aggressi#e intra#enous antibiotic therapy, there was no impro#ement in #ision= although ocular motility returned to normal. ! The mechanism of #ision loss in 0onnel et al.! case remained unknown. The authors postulated streptococcal related ischemic necrosis of the posterior aspect of the optic ner#e as a possible mechanism of #ision loss. 'n a recent sur#ey of ;. patients with orbital cellulitis, ,> (8;:% presented with decreased #isual acuity= howe#er, with long term follow up, only two (9:% patients had decreased #ision.; P%E&#SPOS#$( )*CTO%S The most common predisposing factor for orbital cellulitis is sinus disease, particularly in the younger age groups.,,; The infection most commonly originates from sinuses ?Figure .@, eyelids, face, dental abscess, retained foreign bodies, or distant soources by hematogenous spread.,,;,<A,, 0handler et al.8has grouped complications of sinusitis into fi#e classes. 'n group ,, the eyelids are swollen with the presence of orbital content edema (preseptal cellulitis%. The swelling reflects an impedance to drainage through ethmoid #essels. Benous congestion is transmitted through the #al#eless #eins to the eyelids and through the superior ophthalmic #ein to the orbit. 'n group '' (orbital cellulitis%, there is a diffuse infiltration of orbital tissues with inflammatory cells. The eyelids may be swollen and there may be conCuncti#al chemosis with #ariable degree of proptosis and #isual loss. 'n group ''' (subperiosteal abscess%, purulent material collects periorbitally and in the bony walls of the orbit. There is pronounced eyelid edema, conCuncti#al chemosis, and tenderness along the affected orbital rim with #ariable degree of motility, proptosis, and #isual acuity changes depending on the si$e and location of the abscess. 'n group 'B (orbital abscess%, there is a collection of pus inside or outside the muscle cone due to progressi#e and untreated orbital cellulitis. )roptosis, conCuncti#al chemosis, decreased ocular motility, and #isual loss may be se#ere in these cases. 'n group B (ca#ernous sinus thrombosis%, there is an e1tension of orbital infection into the ca#ernous sinus that can lead to bilateral marked eyelid edema and in#ol#ement of the third, fifth, and si1th cranial ner#es. There may be associated generali$ed sepsis, nausea, #omiting, and signs of altered mentation. 5n orbital ape1 syndrome, characteri$ed by proptosis, eyelid edema, optic neuritis, ophthalmoplegia, and neuralgia of the ophthalmic di#ision of the fifth cranial ner#e is caused by sinus disease around the optic foramen and superior orbital fissure The outcomes from one of the largest series of orbital cellulitis from a de#eloping country confirms pre#ious obser#ations from 6estern countries in which sinus infection has been implicated as the cause of orbital cellulitis in most of the reported cases., Specifically in the pediatric population, up to <-: of patients with orbital cellulitis had e1isting sinusitis, with almost half ha#ing multiple sinus in#ol#ement.

Dnlike patients in 6estern countries, most patients with sinusitis and orbital cellulitis sought treatment later in the course of their disease in this study. 5fter sinusitis, periocular trauma and history of ocular or periocular surgery were the cause of a significant number of cases of orbital cellulitis among these patients, compared with the studies of orbital cellulitis from 6estern countries. ;,> Eess commonly reported causes of orbital cellulitis, such as dacryocystitis, dental infection, and endophthalmitis also were found among these patients ?Figure 8@. Sinusitis may also produce osteomyelitis and intracranial abscess. Osteomyelitis, commonly in#ol#ing the frontal bone, is a direct e1tension of frontal infection or septic thrombophlebitis #ia the #al#eless sinus of Breschet. ,8 Osteomyelitis is rare in the ethmoids because from this location, infection can rapidly spread through the thin lamina papyracea into the orbit or ma1illa, where arterial anastomoses are sufficient to pre#ent necrosis due to septic thrombosis of a single artery. 5lthough meningitis is the most common intracranial complication of sinus disease, epidural, subdural, and brain parenchymal abscess can also occur.,8

#$+EST#(*T#O$S 5lthough ultrasonography (DFS% can be useful as an in office screening procedure in cases of suspected orbital abscesses, 0T scan is necessary to assess the sinuses and intracranial e1tension. On orbital DFS, orbital abscess may show low internal reflecti#ity. On 0T scan, one may see a locali$ed, generally homogenous ele#ation of the periorbita adCacent to an opacified sinus. 'maging studies may show e#idence of inflammatory or infecti#e changes in the orbital structures. 'n the pediatric group, more patients may ha#e subperiosteal abscess as compared to the adult group at the time of initial presentation. For e1ample, in the series reported by Ferguson and 3cGab,; among children, .<: had inflammatory change only, 6.: had a subperiosteal abscess, while only <: had orbital abscesses, compared with !.:, ;:, and ..:, respecti#ely, in the adult group. 'n addition to its essential role in the diagnosis of orbital abscess, 0T scan may also influence the initial therapeutic plan by demonstrating the si$e and location of the abscess and the specific sinuses in#ol#ed, factors that may be considered if surgical drainage is considered.,,,6 "owe#er, 0T scan characteristics of subperiosteal collection may not be predicti#e of the clinical course. For e1ample, the findings in patients who reco#ered with antibiotic therapy alone were similar to the findings in patients who underwent surgical drainage.,! 't has been shown that the si$e of an orbital abscess on imaging studies may increase during the first few days of intra#enous antibiotics regardless of the bacteriologic response to the treatment. ,! The identification of orbital abcess is a diagnostic challenge. The reliability of 0T scan in demonstrating orbital abcess has been &uestioned. 'n a series of .; cases of orbital infection, all ,;

orbital abscesses were satisfactorily demonstrated pro#ided the 0T e1amination included coronal sections..> 5ccording to this study, one third of abscesses would ha#e been missed if coronal sections had been omitted. 3agnetic resonance imaging (34'% may be necessary in some cases where 0T scan ha#e not satisfactorily addressed clinicianHs concerns with other imaging techni&ues. The de#elopment of an orbital abscess does not correlate specifically with #isual acuity, proptosis, chemosis, or any other sign.,8 Therefore, diagnostic procedures are essential in e#aluating the patient with orbital cellulitis for possible abscess or retained orbital foreign body. Sinus 1 ray can demonstrate an air fluid le#el, if present, in an abscess ca#ity= howe#er, gas free abscesses may not be readily #isible.,8 Dltrasound can detect an abscess of the anterior orbit or medial wall with <-: efficiency,.-although an acute abscess may be poorly delineated. The in#estigati#e procedure of choice to diagnose orbital infection is the 0T scan.,,.< Orbital walls, e1traocular muscles, optic ner#e, intraconal area, and adipose tissue can be clearly seen. 5n orbital abscess is #isuali$ed as a homogenous, a ring like, or a heterogeneous mass and the site of origin, orbital or subperiosteal, and e1tent of abscess are readily #isible.,,,! 0ontrast media can enhance the surrounding wall of an abscess. 0T scan does not differentiate between preseptal cellulitis and eyelid edema but will differentiate between preseptal and orbital cellulitis. ,8 Sinus disease and intracranial complications will also be e#ident on 0T scan, as will most foreign bodies. Thus, 0T scan is the most comprehensi#e source of information on orbital infections and the most sensiti#e means of monitoring the resolution of orbital or intracranial lesions. 0T scan is indicated in all patients with periorbital inflammation in whom proptosis, ophthalmoplegia, or a decrease in #isual acuity de#elops, also in cases where a foreign body or an abscess is suspected, in cases where se#ere eyelid edema pre#ents an ade&uate e1amination, or in whom surgery is contemplated.,,,8,,6,,!,.< 1o to: ,*CTE%#O-O(. O) O%,#T*- *,SCESSES 0ommonly reported bacteria from the abscesses of the orbit include Staphylococcus aureus, Staphylococcus epidermidis, Streptococci , *iphtheroids, Haemophilus influenza, Escherichia coli and multiple species including aerobes and anaerobes. Go growth in up to .;: of abscesses.,8 The results of microbiological in#estigation by Ferguson and 3cGab; #aried with differences in the rate of testing between the pediatric age group and the older age group. Some form of culture was performed in <8: of their patients.; 5mong ;-: of patients, who had blood cultures performed, none yielded positi#e results.; 'n their; study, cultures taken from abscesses were

more likely to produce positi#e results. There was no correlation between conCuncti#al swab cultures and the etiological organism reco#ered from the abscesses of patients with positi#e cultures.; S. aureus was the most common pathogen.; 'n the pediatric group #arious species of Streptococcus predominated.; 5naerobic Streptococcus was isolated in four pediatric patients, two cases with mi1ed anaerobes and one with Clostridium bifermentans.; 5naerobic orbital cellulitis was much less common in adults, with only one case of mi1ed anaerobes. 3ultiple organisms were isolated in only fi#e adults and four pediatric patients. Go pathogens were isolated from si1 adults and ,; pediatric patient by Ferguson and 3cGab.; 'n the past,H. influenza was a maCor pathogen responsible for orbital cellulitis in the pediatric age group. ,,,8 'n the series reported by Ferguson and 3cGab,; no cases of H. influenza were detected in the pediatric age group and only one case was found in an adult patient. The authors; attributed this obser#ation due to the general immuni$ation of children with H. influenza type B #accine since the early ,<<-s. The bacteriology of orbital abscesses has recei#ed little attention. 'n a study of cultures of the contents of the abscess ca#ity, a wide range of organisms including S. aureus, S. epidermidis and Streptococci, H. influenza, E. coli, and diptheroids ha#e been reported. The role of anaerobes, not usually considered pathogens in sinus disease, is unclear. "owe#er, a considerable number of cultures in adults ha#e yielded anaerobes.,,,6,,> )atients in the first decade of life generally ha#e infections caused by single aerobic pathogens which are usually responsi#e to medical therapy alone. )atients older than ,; years of age ha#e comple1 infections caused by multiple aerobic and anaerobic organisms that are slow to clear despite medical and surgical inter#ention.,> The comple1ity of pathogens and responsi#eness to antimicrobial therapy appear to be age related.,6,8- 5s the si$e of the sinus ca#ities enlarge, the ostia appear to narrow with increasing age creating optimal conditions for anaerobic bacterial growth. 6ith increasing age, there is a trend toward more comple1 infections. 'n mi1ed infections, aerobes consume o1ygen which encourages anaerobic microbial growth. 5dditionally, anaerobes produce B lactamase that renders antibiotics ineffecti#e. "arris,,6 re#iewed the microbiology results of 8! of his patients with orbital abscesses. Twel#e patients were younger than < years. Of these, ;>: were culture negati#e and the rest had a single aerobic pathogen. Si1teen patients between ages <A,9 years showed a transition toward more comple1 infections.,6 Gine patients older than ,; years, were all culture positi#e after more than 8 days of antibiotic therapy. From the older group, polymicrobial infections were reco#ered more often and anaerobes were found in all cases.,6

From their #ast e1perience with orbital abscesses, "arris and /arcia, ,> concluded that surgical therapy for orbital abscesses should be influenced by se#eral factors, including the #isual status, the si$e and location of the orbital abscess, intracranial complications, the sinuses in#ol#ed, the presumed pathogens, and the anticipated bacterial response to antibiotic treatment. "arris and /arcia recommended emergency drainage of the orbital abscesses and sinuses of patients of any age whose optic ner#e or retinal function is compromised. Drgent drainage was also recommended for large abscesses or e1tensi#e superior or inferior abscesses that might not resol#e &uickly, e#en if sinusitis is medically cleared. Drgent drainage was also recommended for intracranial complications at the time of presentation and in frontal sinusitis, in which the risk of intracranial e1tension is increased, and when comple1 infections that include anaerobesare suspected. 5n e1pectant approach has been recommended for patients younger than < years of age in whom simple infections are suspected. Surgery may be warranted if( there is no clinical impro#ement in a timely manner= relati#e afferent pupillary defect de#elops at any time= fe#er does not abate within 86 h, suggesting that the bacteremia is not responding to the choice of antibiotics= if there has been deterioration despite 9> h of appropriate antibiotic therapy or no impro#ement despite !. h of treatment. 'mpro#ement of 0T findings should be e1pected to lag behind the clinical picture. 'n fact, the 0T findings may seem worse during the first few days of hospitali$ation despite successful treatment with antibiotics alone.,! 3icrobes can cause necroti$ing lid disease that is often referred as necroti$ing fascitis.!,8,A88 This may progress to systemic manifestation including potentially fatal to1ic streptococcus syndrome, characteri$ed by multiorgan failure. 8,,88 These complications can occur in the absence of antecedent health problems or history of trauma.!,8.,88 The #irulence of this organism is related to the production of 3 proteins and e1oto1ins 5 and B.89 These proteins act as super antigens in vitro and mediate tissue necrosis by causing massi#e release of cytokines such as tumor necrosis factors and interleukins. 1o to: T%E*T E$T 'ntra#enous antibiotics are usually started once the diagnosis of orbital cellulitis is suspected. Broad spectrum antibiotics that co#er most gram positi#e and gram negati#e bacteria should be selected. 5ntibiotic recommendations are based on the microorganisms most fre&uently reco#ered from abscesses= S. aureus, S. epidermidis, Streptococci, and Haemophilus species.,8 3i1ed infections including aerobic and anaerobic species may be found.,6 0ultures from the conCuncti#a, nose

and throat are usually not representati#e of the pathogens cultured from the abscesses and blood cultures may be fre&uently negati#e. ,8 'n many studies, a combination of a third generation cephalosporin and fluclo1acillin is used. ,,; 3ost patients recei#e oral antibiotics on discharge for #arying periods of time. For e1ample, all patients in the Ferguson and 3cGab; study recei#ed intra#enous antibiotic treatment and most of their patients had recei#ed multidrug therapy with up to fi#e different antibiotics. 'n all cases treatment regimens were empirically based and instituted prior to identification of the pathogens.; )atient age has been identified as a factor in the bacteriology and response to treatment of orbital abscess. 'n general, children less than < years of age ha#e been found to ha#e simpler, more responsi#e infections, primarily in#ol#ing a single aerobic pathogen. Older children and adults may ha#e more comple1 infections caused by multiple aerobic and anaerobic organisms, refractory to both medical and surgical treatment.,6 'n addition to starting intra#enous antibiotics, emergent drainage of the orbital abscesses has been suggested in patients with compromised #ision regardless of age. Drgent drainage (within .9 h of presentation% has been recommended for large abscesses, for e1tensi#e superior or inferior orbital abscesses, for patients with intracranial complications, for infections of known dental origin in which anaerobes might be e1pected.,6 5n indi#iduali$ed therapeutic approach re&uires a clinician to carefully follow these children and to e1ercise surgical option if impro#ement does not occur in a timely fashion. 0areful monitoring of the clinical course is mandatory and comparison of serial 0T scan may be necessary as an adCunct to clinical Cudgment. 'n a pre#ious study by "arris, ,6 children younger than < years old reco#ered with antibiotic treatment alone with successful clinical outcomes. "arris,6 describes a Isliding scaleJ of risk associated with increasing age and argues that patients in the older age group who present with orbital cellulitis should undergo prompt sinus surgery, e#en before orbital or intracranial abscesses de#elop. Once sinus infection in older children or adults has e1tended in the orbit as an abscess, urgent drainage should include the orbit and all infected sinuses. ,6 0T scan may not be accurate in assessing clinical course in some of these patients. 'n a re#iew of 8! cases of orbital abscesses, "arris,6, found that subperiosteal material could not be predicted from the si$e or relati#e radiodensity of the collections in 0T scans.,! 'nitial scans were not predicti#e of the clinical course. Serial scans showed enlargement of abscesses during the first few days of intra#enous antibiotic therapy, regardless of the ultimate response to treatment. "arris, concluded that e1pansion of orbital abscess in serial 0T scans during the first few days of treatment should not be e&uated to failure of the infection to respond to antibiotics alone.,! 1o to:

S'%(#C*- #$TE%+E$T#O$ Surgical treatment is indicated for significant underlying sinus disease, orbital or subperiosteal abscess or both in the pediatric age group. 'n adults, sinus surgery remains the most common surgical inter#ention. The argument remains between early drainage of orbital abscess to pre#ent complications #ersus the possibility of seeding the infection through early surgery.,6 "arris has outli#ed a useful approach in the management of an orbital abscess.,6 "e recommends emergency drainage for patients of any age, whose #isual function is compromised. Drgent drainage, usually within .9 h, is indicated for the following( large orbital abscess causing discomfort, superior or inferior orbital abscess, e#idence of intracranial e1tension, in#ol#ement of frontal sinuses, and a known dental source of the infection in patients older than < years ?Figure 9@.,6 5n e1pectant approach is indicated for patients younger than < years with medial subperiosteal abscess of modest si$e, no #isual loss and no intracranial or frontal sinus in#ol#ement. 0areful e#aluation and close monitoring of the optic ner#e function and the le#el of consciousness and mental state of the patient is #ery important. 5n incision down to the periosteum at the inner &uadrant of the orbit may be made to drain the subperiosteal abscess. 5 drain may be inserted and tissues may not need to be sutured, but left to granulate. The drain may be left in place for !A> days. Functional endoscopic sinus surgery (F+SS% has been shown to be effecti#e for the treatment subperiosteal abscess due to complication of paranasal sinusitis. The ad#antage of F+SS is the a#oidance of e1ternal ethmoidectomy and associated e1ternal facial scar and an early drainage of the affected sinuses and subperosteal abcess.8;

EC/*$#S

O) +#S'*- -OSS #$ O%,#T*- CE--'-#T#S

)ermanent loss of #ision has been noted as a complication of orbital infection since ,><8 and blindness was reported in up to .-: of patients with postseptal inflammation in the preantibiotics era.6 "owe#er, permanent loss of #ision resulting from orbital inflammation is unusual in this era of antibiotics..-,.,'n a pre#ious study, 9 of 8> patients with postseptal disease had permanent loss of #ision with one of these patients progressing to no light perception.., The mechanism for loss of #ision with orbital inflammation may in#ol#e( (,% optic neuritis as a reaction to adCacent or nearby infection= (.% ischemia resulting from thrombophlebitis along the #al#eless orbital #eins or= (8% compressi#eFpressure ischemia possibly resulting in central artery occlusion.6,., Because clinical e1amination by itself may not e1actly delineate the nature of postseptal inflammatory processes, clinicians may ha#e to rely on imaging studies to select potential surgical candidates. *espite modern imaging

techni&ues, the clinician must rely on the clinical progression of the inflammation based on #isual acuity testing, pupillary reacti#ity, and ocular motility assessment. )att and 3anning,., reported four cases of permanent blindness as a result of postseptal orbital inflammation. 'n each case, 0T scan readings of Ino definite abscessJ contributed to delay in diagnosis of orbital abscess, with a resultant delay in surgical drainage. The ethmoidal sinuses are separated from the orbital contents by the lamina papyracea and anterior and posterior ethmoidal foramina ser#e as additional connections that may allow infection to gain access from ethmoidal air cells to the orbital contents. The periorbita in this area is loosely attached to bone and may be ele#ated by a purulent collection, resulting in subperiosteal abscess. Se#ere irre#ersible #isual loss may occur in cases with orbital and subperiosteal abscess. 'n a sur#ey of 96 cases with a confirmed diagnosis of orbital and subperiosteal abscess in which #isual results were reported, permanent blindness de#eloped in se#en (,;:% cases.86 'n four cases, blindness was attributed to central retinal artery occlusion, in two cases optic atrophy occurred, and in one case no details were pro#ided. 'rre#ersible #isual loss in orbital cellulitis probably has a #ascular cause, whereas cases with re#ersible #isual loss that respond to antibiotic therapy and drainage procedures most likely are due to infiltrati#e or compressi#e optic neuropathy. The confinement of the optic ner#e in the orbital ape1 and within the bony canal and its pro1imity to the posterior ethmoid and sphenoid sinuses magnify the importance of the casual factors in posterior orbital cellulitis. 0linicians should be aware that patients with sinusitis and associated orbital cellulitis are at risk for de#eloping se#ere #isual loss and should be treated promptly. "ornblass ,8 re#iewed ,9> patients from ,8 series reporting orbital abscess and found three cases of no light perception #ision. 5cute #isual loss may be associated with acute sinusitis either secondary to complicated orbital cellulitis or as a part of the orbital ape1 syndrome. 8! +l Sayed and 3uhaimeid,8! reported two cases of acute #isual loss as a complication of orbital cellulitis due to sinusitis. 'n one patient dramatic impro#ement in #ision from hand motion to normal #ision resulted after intra#enous treatment of pansinusitis and associated orbital cellulitis.8! 5 second patient (a ,- year old female% reco#ered #ision from no light perception to normal le#els after e1ploration of the sphenoid and ethmoid sinuses along with intra#enous antibiotics. Sla#in and /laser, 86,8! described three cases of sphenoethmoiditis causing irre#ersible #isual loss associated with minimal signs of orbital inflammation and renamed the entity Iposterior orbital cellulitis.J Sla#in and /laser86,8! defined it as a clinical syndrome in which early se#ere #isual loss o#ershadows or precedes accompanying inflammatory orbital

signs. 5cute blindness may also result from orbital infarction syndrome. Orbital infarction is a disorder that may occur secondary to different mechanisms such as( (i% acute perfusion failure, that is, common carotid artery occlusion= (ii% systemic #asculitis, that is, giant cell arteritis= (iii% orbital cellulitis with #asculitis, that is, mucurmycosis. The blindness and retinal and optic ner#e damage can be permanent.8> 'n de#eloping countries, most patients with sinusitis and orbital abscess tend to present late in the course of the disease. 3ost patients with refractory or complicated subperiosteal abscesses are older children or adults. For e1ample, in one of the largest studies reported, four patients were permanently blind out of ,;< patients with orbital complications of sinusitis.., 5ll four had surgically confirmed subperiosteal abscess, and all were ,; years of age or older. 'n another study, among the ,8 patients with intracranial abscess that resulted from sinusitis or orbital abscesses, two patients were < to ,9 years of age and ,, were ,; years of age or older. 9

Penyebab &an (e0ala Selulitis Orbitalis

selulitis orbitalis Penyebab Selulitis Orbitalis 2enyebab ter!adinya selulitis orbitalis adalah infeksi bakteri. "nfeksi bisa berasal dari sinus, gigi atau aliran darah, atau bisa ter!adi setelah suatu cedera mata. 2ada anakanak, selulitis orbitalis biasanya berasal dari infeksi sinus yang disebabkan oleh $emophilus influen3ae. 0akteri lainnya yang bisa menyebabkan selulitis orbitalis adalah 'taphylococcus aureus, 'treptococcus pneumoniae dan streptokokus beta hemolitikus yang menyerang tubuh penderita. 4ondisi predisposisi untuk selulitis termasuk gigitan serangga, melepuh, gigitan hewan, tato, ruam gatal kulit, operasi terakhir, athletes foot, kulit kering, eksim, obat suntikan (terutama subkutan atau in!eksi intramuskular atau mana in!eksi "5 berusaha 6merindukan7 atau pukulan vena), kehamilan, diabetes dan obesitas, yang

dapat mempengaruhi sirkulasi, serta luka bakar dan bisul, meskipun ada perdebatan mengenai apakah lesi kaki kecil berkontribusi. 'elulitis disebabkan oleh !enis bakteri memasuki kulit, biasanya dengan cara dipotong, abrasi, atau istirahat di kulit. "stirahat ini tidak perlu terlihat. 'treptococcus 1rup *77dan77aureus adalah yang paling umum dari bakteri ini, yang merupakan bagian dari flora normal kulit tetapi tidak menyebabkan infeksi yang sebenarnya, sementara di permukaan luar kulit. 2enampilan kulit akan membantu dokter membuat diagnosis. /okter mungkin !uga menyarankan tes darah, budaya luka atau tes lainnya untuk membantu menyingkirkan gumpalan darah di dalam pembuluh darah kaki. 'elulitis di tungkai bawah ditandai dengan tanda dan ge!ala yang mungkin serupa dengan bekuan ter!adi !auh di dalam pembuluh darah, seperti kehangatan, nyeri dan pembengkakan (inflamasi). "ni memerah kulit atau ruam mungkin sinyal infeksi lebih dalam, lebih serius dari lapisan dalam kulit. 'etelah di bawah kulit, bakteri dapat menyebar dengan cepat, memasuki kelen!ar getah bening dan aliran darah dan menyebar ke seluruh tubuh. /alam kasus yang !arang ter!adi, infeksi dapat menyebar ke lapisan dalam dari !aringan yang disebut lapisan fasia. %ecroti3ing fasciitis, !uga disebut oleh media 6bakteri pemakan daging,7 adalah contoh dari infeksi yang mendalam-lapisan. "ni merupakan keadaan darurat medis ekstrim. (e0ala Sakit mata selulitis Orbitalis 'akit mata selulitis Orbitalis ('O) memiliki ge!alan yaitu seperti :

-.ata .erah

-.ata nyeri

-4elopak mata bengkak

-0ola mata menon!ol dan bengkak

-/emam -Tampak berkabut

2emeriksaan untuk penyakit 'akit mata selulitis Orbitalis ('O) ini bisa dicek melalui rontgen gigi dan mulut atau -T 'can sinus. 'O yang tak segera ditangani bisa berakibat fatal, seperti kebutaan, infeksi otak atau pembekuan darah di otak. Penanganan Sakit mata selulitis Orbitalis 2enanganan ge!ala sakit mata selulitis orbitalis dapat dilakukan tindakan yaitu : -2enderita sakit mata selulitis orbitalis diberikan antibiotika secara oral. -2enderita sakit mata selulitis orbitalis bisa diberikan operasi pembedahan untuk mengeluarkan nanah &iagnosa Selulitis Orbitalis .endiagnosa harus ditegakkan berdasarkan ge!ala dan hasil pemeriksaan fisik. +ntuk menentukan penyebabnya bisa dilakukan rontgen gigi dan mulut atau -T scan sinus. -ontoh !aringan dari selaput mata, kulit, darah, tenggorokan atau sinus bisa dibiakkan di laboratorium untuk menentukan bakteri penyebab infeks tersebuti. Cara engobati Selulitis Orbitalis

2engobatan dilakukan adalah pada kasus yang ringan diberikan antibiotik per-oral dan untuk kasus yang berat antibiotik diberikan secara intravena (melalui pembuluh darah). 4adang perlu dilakukan pembedahan untuk membuang nanah atau mengeringkan sinus yang terinfeksi

Periorbital and Orbital Cellulitis

Presentation

Management - Orbital Cellulitis !his is a sur#ical emer#enc". 3fter consultation with the 56! sur#eons and ophthalmolo#ists an ur#ent C! scan should be arran#ed to differentiate those patients with an associated abscess (usuall" subperiosteal) from those

without. !his should be discussed with the radiolo#ist who will as- for coronal views. Ima#in# should pa" particular attention to the orbital and frontal re#ions as the abscess ma" be small. .ur#ical draina#e of an abscess results in decompression of the orbit and obtains infected material for 7ram stain and culture. /i-el" or#anisms include .trep p"o#enes .trep pneumoniae and .taph aureus. Over 8 "ears .taph aureus is more common. 'aemophilus influen9ae t"pe b is less common since 'i% immunisation. Recommended antibiotics i.v. Ceftriaxone 8: m#;-#;dose (0#) iv <0' and i.v. flucloxacillin 8: m#;-#;dose =-hourl" (maximum 0 #;dose). /umbar puncture is contraindicated in patients with orbital cellulitis until after the C! scan has been performed even in the absence of features of raised intracranial pressure since intracranial extension ma" be silent. Management - Periorbital Cellulitis Investi#ation of these patients should include )%5 blood cultures. /i-el" or#anisms include .trep p"o#enes .trep pneumoniae and .taph aureus. .trep p"o#enes and .taph aureus are li-el" if there is a conti#uous s-in lesion. >arel" 'aemophilus influen9ae ma" be the cause particularl" in children under five who are not full" immunised. 'aemophilus bacteraemia-induced periorbital cellulitis and 'aemophilus menin#itis occasionall" coexist. !he decision as to whether a lumbar puncture should be performed should be a clinical one.

Recommended antibiotics (ild Amoxycillin/Clavulanate (400/57 mg per 5 mL) 0.3 mL/kg (11 mL) po 1 !

(oderate

"lucloxacillin 50 mg/kg ( g) iv #!

$evere% or &5y ' not !i( immuni)e*

1lucloxacillin .8 mg@5g (% g) iv A' and 3eftriaxone .8 mg@5g@dose (%g) iv 1%'

In children who are s"stemicall" unwell it ma" be reasonable to use both Ceftriaxone 8: m#;-#;dose (0#) iv <0' and flucloxacillin initiall". 3n" child in whom there is a reasonable suspicion of primar" s-in infection or who is not improvin# on Ceftriaxone 8: m#;-#;dose (0#) iv <0' alone should have flucloxacillin added. )ailure to respond in 01-12 hours ma" indicate orbital cellulitis or underl"in# sinus disease. !reat as for orbital cellulitis. When improvin# and no or#anism identified chan#e to au#mentin 08 m#;-#;dose 2-hourl" (maximum 8:: m#;dose) for ? da"s. Prophylaxis

If 'aemophilus influen9ae t"pe b is isolated rifampicin proph"laxis should be #iven as for menin#itis that is if a child a#ed 8 "ears or less lives in the same household as the index case or if the index case is @ 0 "r then proph"laxis should be #iven to the entire household includin# the index case. +arents who are pre#nant should not be #iven rifampicin. +atients should be warned that rifampicin will colour the urine tears and other secretions oran#e oran#e tears ma" discolour contact lenses. >ifampicin induces the metabolism of the oral contraceptive pill ma-in# this form of contraception unreliable. Doses:

@ < monthA <: m#;-# once dail" for 1 da"s B < monthA 0: m#;-# once dail" for 1 da"s 3dultsA =:: m# once dail" for 1 da"s

3ll children a#ed @ 8 "r who have not been immunised a#ainst 'ib should be vaccinated. If children are @ 0 "r and have had a documented 'aemophilus infection the" should be immunised. Local allergic reactions

In the absence of local and s"stemic si#ns of infection e# temperature or tenderness periorbital er"thema ma" be an aller#ic reaction rather than periorbital cellulitis.

What is orbital cellulitis? Orbital cellulitis is an infection or inflammation of the orbit. 'ince the orbit has direct communications with the sinuses, infection can spread into the orbit in a patient with a sinus infection. Orbital cellulitis is potentially much more serious than preseptal cellulitis. What causes orbital cellulitis? 'pread of infection is the most common cause of orbital cellulitis. -auses include:

8 'inusitis (the most common cause) 8 Trauma or foreign body 8 "nfection from the blood 8 Tooth abscess How is orbital cellulitis evaluated? * history and physical e9amination is performed. 0lood may be tested for infection. *n imaging study (-T scan or .,") may be obtained to evaluate for spread into and possibly beyond the orbit. How is orbital cellulitis treated? Treatment for orbital cellulitis usually involves admission to the hospital for close observation and intravenous antibiotic therapy. -onsultation by an Ophthalmologist and possibly an #ar-%ose ( Throat specialist are often recommended . 'urgery to drain the orbital and sinus infection may be necessary if the condition does not improve or worsens. 2atients are monitored carefully for loss of vision or evidence of pressure on the optic nerve. What are the complications of orbital cellulitis? 'pread to surrounding tissue can cause significant worsening of the illness. 'pread to the brain from the sinuses and orbit may cause a brain abscess (walled off infection), meningitis (infection in tissues surrounding the brain) and:or hydrocephalus (increased pressure in the brain). These serious complications often re;uire intensive care and possibly emergency surgery. ,arely, these complications may result in death.$owever, orbital cellulitis usually responds to proper treatment and there is generally full recovery Eye Socket #n!ection (Orbital Cellulitis) What is orbital cellulitis? Orbital cellulitis is a severe infection inside your eye socket, which is called the orbit. Orbital cellulitis is an emergency. "t can cause permanent blindness if not treated right away.

What is the cause? #ye socket infections can start after a surgery or an in!ury to the eye. 'inus or dental infections, or skin infections around your eye and eyelids can spread to your eye socket through the thin bones and veins near your eye. *lso, an infection that starts somewhere else in your body can spread through the bloodstream to your eye. #ye socket infections are usually caused by bacteria. )ungus may cause this infection if you have if your immune system is weakened by diabetes, $"5, chemotherapy, or other conditions. )ungus is a kind of germ. "t includes things like yeast, mold, and mildew. What are the symptoms? 'ymptoms may include:

/ecreased vision or double vision 2ain, swelling, and redness in and around your eye &atery, yellow, or green discharge from your eye )ever 2roblems moving your eye in one or more directions One eye looks like it bulges forward compared to the other eye

<ou may have a runny nose or a stuffy nose with these symptoms. How is it diagnosed? <our eyecare provider will ask about your symptoms and medical history, and do e9ams and tests such as:

*n e9am using a microscope with a light attached, called a slit lamp, to look closely at the front and back of your eye *n e9am using drops to enlarge, or dilate, your pupils and a light to look into the back of your eyes -T scan, which uses 9-rays and a computer to show detailed pictures of your eye socket

.,", which uses a strong magnetic field and radio waves to show detailed pictures the bones and tissues of your eye socket and sinuses =ab tests of the discharge from your eye 0lood tests to check for signs of infection and bacteria in the blood

How is it treated? "f the infection is found and treated ;uickly, you may have no loss of vision. <ou may need to stay in the hospital and receive medicines to treat the infection through an "5. <ou may need surgery to drain the infection. How can I take care of myself? )ollow the full course of treatment your healthcare provider prescribes. *sk your healthcare provider:

$ow and when you will hear your test results $ow long it will take to recover &hat activities you should avoid and when you can return to your normal activities $ow to take care of yourself at home &hat symptoms or problems you should watch for and what to do if you have them

.ake sure you know when you should come back for a checkup. How can I prevent an eye socket infection? "f you think you have an infection of the skin around your eye or of your eyelids, contact your healthcare provider. "f you have a history of sinus infections and develop eye symptoms, you should also seek medical attention.

Selulitis Orbita *kut o 'uatu keadaan akut dari !aringan orbita yang disebabkan oleh kuman.

o o

4uman yang sering menyebabkan sinusitis atau dakrioadenitis seperti pneumokok, streptokok atau stafilokok. "nfeksi dapat ter!adi secara langsung dari radang sinus paranasalis, melalui pembuluh darah ( trauma terutama bila ada benda asing yang masuk ke !aringan orbita. 1e!ala klinis:

%yeri. %yeri orbita terutama dirasakan penderita pada perabaan ( pergerakan bola mata. 2alpebra bengkak ( merah. 2enurunan visus 2roptosis 1angguan pergerakan bola mata /iplopia 2anas badan. 2enatalaksanaan: "sterahat total *0 spectrum luas "nfeksi local dicari dan diobati "nsisi abses pada tempat fluktuasi

a. Selulitis Orbita Selulitis orbita merupakan peradangan supuratif Caringan ikat longgar intraorbita di belakang septum orbita. Selulitis orbita akan memberikan geCala demam, mata merah, kelopak sangat edema dan kemotik, mata proptosis, atau eksoftalmus diplopia, sakit terutama bila digerakkan, dan taCam penglihatan menurun bila terCadi penyakit neuritis retrobulbar. )ada retina terlihat tanda stasis pembuluh #ena dengan edema papil.

&*T* PE$.*1#T2 &eskripsi Orbital selulitis adalah infeksi yang berpotensi terhadap komplikasi serius yang berbahaya. 0akteri dari infeksi sinus (sering $aemophilus influen3ae) biasanya menginfeksi anak-anak. 0akteri 'taphylococcus aureus, 'treptococcus pneumoniae, dan betahemolitik streptokokus orbit !uga dapat menyebabkan selulitis. 2enyebab lainnya termasuk tembel di kelopak mata, gangguan gigitan, atau kelopak mata cedera. *nak umur >-? sangat rentan terhadap terinfeksi. %amun, tingkat orbital selulitis telah menurun terus se!ak diperkenalkannya 5aksin $ib ($aemophilus influen3ae 0). Orbital infeksi selulitis pada anak-anak dapat memburuk dengan sangat cepat dan dapat menyebabkan kebutaan. 2erhatian medis segera diperlukan. (e0ala @ /emam, umumnya ABC dera!at ) atau lebih tinggi @ .enyakitkan pembengkakan kelopak mata atas dan bawah @ .engkilat, merah atau ungu kelopak mata @ .ata sakit, terutama dengan gerakan @ 2enurunan pandangan @ .ata melotot @ 1eneral malaise @ 'akit atau sulit menggerakan mata Pengobatan 2asien biasanya perlu tinggal di rumah sakit. 2erawatan termasuk antibiotik diberikan melalui vena. 2embedahan mungkin diperlukan untuk mengeringkan abses. Orbital infeksi selulitis dapat men!adi lebih buruk dengan sangat cepat. 2asien harus diperiksa setiap beberapa !am.

Selulitis Orbita A.

Definisi $eluliti) or(ita a*ala+ pera*angan )upurati, -aringan ikat -arang intraor(ita *i (elakang )eptum or(ita. 1 $eluliti) or(ita -arang merupakan penyakit primer rongga or(ita. .ia)anya *i)e(a(kan ole+ kelainan pa*a )inu)parana)al *an yang terutama a*ala+ )inu) etmoi*. $eluliti) or(ita *apat mengaki(atkan ke(utaan% )e+ingga*iperlukan pengo(atan )egera. /a*a anak0anak% )eluliti) or(itai) (ia)anya (era)al *ari in,ek)i )inu) *an*i)e(a(kan ole+ (akteri !aemop+ilu) in,luen1ae. .ayi *an anak0anak yang (erumur *i(a2a+ #07 ta+untampaknya )angat rentan ter+a*ap in,ek)i ole+ !aemop+ilu) in,luen1ae. B. Epidemiologi /eningkatan in)i*en )eluliti) or(ita ter-a*i *i mu)im *ingin% (aik na)ional maupun interna)ional% karenapeningkatan in)i*en )inu)iti) *alam cuaca. A*a mencatat peningkatan ,rekuen)i )eluliti) or(ita pa*a ma)yarakat*i)e(a(kan ole+ in,ek)i $tap+ylococcu) aureu) yang re)i)ten met+icillin.1. 3ortalita) / 3or(i*ita)$e(elum keter)e*iaan anti(iotik% pa)ien *engan )eluliti) or(ita memiliki angka kematian *ari 174% *an 04 *ari kor(an yang )elamat (uta *i mata yang terkena. 5amun% *engan *iagno)i) yangcepat *an tepat penggunaan anti(iotik% angka ini tela+ (erkurang )ecara )igni,ikan6 ke(utaan ter-a*i*alam 114 ka)u). $eluliti) or(ita aki(at $. aureu) yang re)i)ten ter+a*ap met+icillin *apatmenye(a(kan ke(utaan me)kipun tela+ *io(ati anti(iotik. . 7a)$eluliti) or(ita ti*ak *ipengaru+i ole+ ra)ial.3. $ex8i*ak a*a per(e*aan ,rekuen)i antara -eni) kelamin pa*a orang *e2a)a% kecuali untuk ka)u)0ka)u) $. aureu) yang re)i)ten ter+a*ap met+icillin% yang le(i+ )ering ter-a*i pa*a 2anita *aripa*a laki0laki *engan ra)io 491. 5amun% pa*a anak0anak% )eluliti) or(ita tela+ *ilaporkan *ua kali le(i+ )ering ter-a*i pa*a laki0laki *aripa*a perempuan.4. :)ia$eluliti) or(ita% pa*a umumnya% le(i+ )ering ter-a*i pa*a anak0anak *aripa*a *i *e2a)a mu*a.;i)aran u)ia anak0anak yang *ira2at *i ruma+ )akit *engan )eluliti) or(ita a*ala+ 701 ta+un.

Etiologi dan Patofisiologi $eluliti) or(ita merupakan pera*angan )upurati, yang menyerang -aringan ikat *i )ekitar mata%*an ke(anyakan *i)e(a(kan ole+ (e(erapa -eni) (akteri normal yang +i*up *i kulit% -amur% )arkoi*% *anin,ek)i ini (ia)a (era)al *ari in,ek)i *ari 2a-a+ )ecara lokal )eperti trauma kelopak mata% gigitan +e2anatau )erangga% kon-ungtiviti)% kala1ion )erta )inu)iti) parana)al yang penye(arannya melalui pem(ulu+*ara+ ((akteremia) *an (er)amaan *engan trauma yang kotor./a*a anak0anak in,ek)i )eluliti) )ering *i)e(a(kan ole+ karena )inu)iti) etmoi*ali) yangmengenai anak antara umur 010 ta+un. A*a .e(erapa (akteri penye(a(% *iantaranya 9 a. Haemophilus influenzae 3erupakan (akteri yang (er)i,at gram negati, *an terma)uk keluarga /a)teuracella. !aemop+ilu)in,luen1ae yang ti*ak (erkap)ul (anyak *ii)ola)i *ari cairan )ere(ro)pinali)% *an mor,ologinya )eperti.or*etella pertu))i) penye(a( (atuk re-an% namun (akteri yang *i*apat *ari *a+ak (e)i,at pleomor,ik *an )ering (er(entuk (enang pan-ang *an ,ilamen.<am(ar !aemop+ilu) in,luen1ae yang *iperole+ *ari *a+ak.!a emop+illu) in,luen1ae *apat tum(u+ *engan me*ia =+eme> ole+ karena me*ia ini merupakan me*ia komplek) *an mengan*ung (anyak prekur)or0prekur)or pertum(u+an k+u)u)nya ,aktor ?(+emin) *an ,aktor @( 5AA *an 5AA/ ). Ai la(oratorium *i tanam *alam agar *ara+ cokelat yang )e(elumnya me*ia tanamter)e(ut *ipana)kan *alam )u+u B0 o C untuk melepa)kan ,aktor pertum(u+an ter)e(ut. .akteri *apattum(u+ *engan (aik pa*a )u+u 35 o C0 3B o C *engan /! optimal )e(e)ar 7%#. .akteri ini *apat tum(u+pa*a kon*i)i aero(ik ( )e*ikit CC ). .akteri ini )ekarang )u*a+ -arang untuk menye(a(kan )eluliti)aki(at (anyaknya tipe vak)ina)i untuk )train ini

Selulit Mata?

Oleh : Dr. Dito Anurogo .> 3ar .-->, ,8(-!(,6 6'B ?www.kabarindonesia.com@

KabarIndonesia - 7ang dimaksud dengan selulit mata disini adalah selulitis orbita. Kadi amat Cauh berbeda dari selulit menurut pengertian awam. 3ari kita pahami apa itu selulitis orbita. De inisi: Selulitis orbita adalah peradangan Caringan ikat yang terdapat di dalam rongga orbita. !en"ebab: ,. Luman piogenik ( neumococcus, Staphylococcus, dan Streptococcus%. .. Eues, Camur, dan sarkoid dapat menyebabkan selulitis orbita kronik. 8. Haemophilus influenzae menyebabkan selulitis orbita pada anak. 9. Staphylococcus aureus dan Streptococcus sp. menyebabkan selulitis orbita pada pada orang dewasa. ;. Trauma tembus yang kotor yang masuk ke dalam rongga orbita. Mani estasi Klinis: ,. Badan terasa panas .. TaCam penglihatan (#isus% menurun 8. )englihatan ganda (diplopia% 9. *aerah yang meradang terasa sakit, terutama pada perabaan. ;. Lelopak mata merah dan bengkak. !. LonCungti#a bulbi berwarna merah. >. )ada perabaan bola mata terasa sangat sakit. <. Terkadamg bola mata sama sekali tidak dapat digerakkan. ,-. Terkadang terlihat perdarahan papil akibat tekanan dari belakang bola mata. ,,. 3alaise (tubuh merasa tidak enak, tidak nyaman% ,.. Eeukositosis (sel darah putih meningkat karena infeksi% ,8. Leadaan umum penderita biasanya buruk sekali. !enatalaksanaan: ,. 'stirahat penuhFtotal dengan dirawat .. 5ntibiotik dosis tinggi intra#ena atau intramuskular yang sesuai. 8. Kika perlu, abses dikeluarkan. Gamun hati hati, karena dapat menimbulkan penyulit baru. !en"ulit: ,. Trombosis sinus ka#ernosus .. 3eningitis 8. 5bses otak 9. )anoftalmitis ;. Geuritis

!rognosis: Sukar diramalkan. Bila pengobatan terlambat, hasilnya lebih buruk. #ahukah Anda? ,. Selulitis orbita Carang merupakan penyakit primer rongga orbita. Biasanya disebabkan oleh kelainan pada sinus paranasal dan yang terutama adalah sinus etmoid. .. Selulitis orbita dapat mengakibatkan kebutaan, sehingga diperlukan pengobatan segera.