• 601 Providence Park Drive, Suite O, Mobile, Alabama,36695
  • 27961 U.S. 98, Thomas Medical Center, Daphne, Alabama,36526
  • 1720 Medical Park Dr, Suite 330a, Biloxi, Mississippi,39532-2131

Orbital Infections


  • 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 may possibly require orbital and sinus exenteration, coupled with both systemic and local treatment with Amphotericin B
  • Adjunct therapy: hyperbaric oxygen therapy may possibly 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 may possibly 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; may possibly lead to meningitis; get neurosurgery consult
Clinical Photo of a patient with a subperiosteal abscess CT of a patient with a subperiosteal abscess