Steven Leibowitz, MD
  • 100 UCLA Medical Plaza, Suite 747, Los Angeles, California,90024
    310-272-0808
  • 653 Town Center Drive, Suite 102, Las Vegas, Nevada,89144
    702-242-5555
  • 8641 Wilshire Blvd, Suite 312, Beverly Hills, California,90211
    310-272-0808
  • 5301 Truxton Avenue, Suite 200, Bakersfield, California,93309
    661-412-2322
  • 299 N. Pecos Road, Henderson, Nevada,89074
    702-242-5555
Procedures

Orbital Infections

Mucormycosis

  • Mucormycosis is a fulminant oportunisitic fungal infection caused by fungi of the class Zygomycetes.
  • PredisORALsing factors: patients who have diabetic ketoacidosis or who are immunocompromised
  • Etiology: Infection begins in the paranasal sinuses and spreads to the orbit. The large, nonseptate hyphae cause vascular occlusion. This causes ischemia and infarction of tissue.
  • Therapy: includes correction of the underlying metabolic abnormality and debridement of all involved infected tissue. It could require orbital and sinus exenteration, coupled with both systemic and local treatment with Amphotericin B
  • Adjunct therapy: hyperbaric oxygen therapy could be beneficial

Orbital cellulitis

  • infectious inflammatory process involving the orbital tissues posterior to the orbital septum and requires
  • Etiologies include trauma, orbital fracture repair, strabismus surgery
  • Extension of pre-existing infections of the face, lacrimal sac, and lacrimal gland which can extend into the orbit
  • Pathophysiology: The most common bacterial pathogens in preseptal cellulitis include Haemophilus influenza, Staphylococcus aureus, and Streptococcus pneumoni
  • Therapy: Subperiosteal abscess formation should be suspected if patients fail to improve or deteriorate on intravenous antibiotics .
    • Infants with preseptal cellulitis are usually admitted for intravenous therapy, whereas
    • older children and adults with preseptal infections could be treated with oral antibiotics. 7- to 10-days of intravenous therapy are required, followed by a course of oral antibiotics for 10 to 14 days
  • infection posterior to orbital septum
  • 90% from extension of acute or chronic bacterial sinusitis, remainder s/p trauma or surgery or 2o to extension from other orbital or periorbital infection, or endogenous w/septic embolization
  • fever, proptosis, restriction of EOM’s, pain on globe movement
  • decreased visual acuity Afferent Pupillary Defect (APD), prolonged high Intraocular pressure (IOP) can be indications for aggressive management to prevent orbital apex syndrome or cavernous sinus thrombosis

Orbital cellulitis

  • CT of orbit and sinuses to confirm sinus disease, rule out mass, rule out orbital foreign body if h/o trauma (even remote), rule out orbital or subperiosteal abscess which will require surgical drainage
  • blood culture then broad spectrum IV antibiotics to cover gram cocci, H. influenzae (although less prevalent in kids 2o to immunization), anaerobes, typically nafcillin and 3rd generation cephalosporin; ID consult if necessary; kids more often single organism
  • progression of infection or no daily improvement on appropriate antibiotics can mean abscess: repeat CT as needed (prn) and drain w/concomitant sinus drainage as needed (prn)
  • cavernous sinus thrombosis: rapid progression of proptosis and neurologic signs of intracranial dysfunction; could lead to meningitis; get neurosurgery consult
Clinical Photo of a patient with a subperiosteal abscess CT of a patient with a subperiosteal abscess

 

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