Tuesday, January 10, 2012

Sinuses infection-induced eye complications

Sinuses infection-induced eye complications

The orbit (eye socket) is structurally located near the sinuses. Thus, sinuses’ infection may cause orbital complications if surgery is delayed, stubborn and virulent organisms are present, host immunity is impaired and medication is inadequate. The sphenoid and ethmoid sinuses bound the orbit medially. The frontal sinus is located superiorly, whereas the maxillary sinus is placed inferiorly. Ethmoid sinuses infection is the main reason of the complications followed by maxillary sinusitis and frontal sinusitis. The problems ascribed to the sphenoid sinusitis are rare. The complications may occur any time in life but generally are common in young children.

How does infection spread?

The infection may reach the orbit due to retrograde thrombophlebitis and direct extension. Retrograde thrombophlebitis means that infection spreads through the valve-less vein network enabling smooth movement between the orbit and the sinuses, nasal cavity and face. The eroded bony wall of the lamina papyracea, congenital body splitting or unstitched suture line may spread the infection.

Types of orbital complications

The orbital complications are divided into five groups: cavernous sinus thrombosis, inflammatory edema, orbital abscess, orbital cellulite and subperiosteal abscess.  Periorbital cellulite is the most common complication.
 
Cavernous sinus thrombosis (CST) is mainly ascribed to infection of the sphenoid and ethmoid sinuses. The infection may spread due to retrograde thrombophlebitis involving the ophthalmic vein or direct extension. Initially, the patient may suffer from periorbital edema, diplopia, photophobia, headache and fever.

Inflammatory edema is also called preseptal or periorbital cellulite. Eyelids swell near the orbital septum, but the orbit’s soft tissues are not affected. The septum prevents infection from spreading into the orbit. If extra ocular movement stops, soft tissues are also affected.

Orbital abscess means pus accumulation within the tissue of the orbit. This complication may lead to proptosis, which means forward displacement or projection of the eyeball, and loss of vision. The abscess may also limit the extra ocular movement.

Orbital cellulite implies inflammation and edema of the orbit area, but there is no abscess. Partial or complete paralysis of eye muscles (ophthalmoplegia), conjunctival edema (chemosis) and proptosis may occur. If the cellulite is not treated, an abscess may develop and the patient may become blind.

Subperiosteal abscess is pus accumulation between the orbital wall bone and the orbital periosteum. During initial stage, displacement may occur in the orbit area. If the infection continues to spread, ocular movement is affected, thereby conjunctival edema develops. The abscess may reach the eyelids.

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