CELULITA ORBITARA

Ruxandra Angela Pascu

ORBITA
 Tavanul- fosa lacrimala
- foseta trohleara
 Planseul- c. suborbitar
 P. extern
 P. intern- vase
- nervi
- dehiscente
Zuckerkandl
 PERIORBITA
 Mb. fibrovasculara(~periost)
 Prelungire a durei- mater
 Septuri spre tesutul celulograsos
 Se dedubleaza in unghiul intern→peretii
lojei sacului lacrimal
 CELULITA ORBITARA
 Inflamatie acuta seroasa difuza/ purulenta
a tesutului celuloadipos al orbitei
 Frecvent copii/ adulti
 Iarna
 17% mortalitate in era preantibiotica
 ETIOLOGIE
 Exogena- posttraumatica:
- plagi perforante pleoape
- corp strain intraorbitar
- iatrogena:
- postoperator- dacriocistorinostomii
- chirurgia pleoapelor
- operatii de strabism
- endoftalmite postoperatorii
- punctie- biopsie
 ETIOLOGIE
 Endogena- bacteriemie prin emboli septici
 Extensie- osteomielita orbitei
- sinusuri paranazale
- fata
- pleoape
- cai lacrimale/ sac lacrimal
- dinti
 AGENTI PATOGENI

 Sinus: S. pneumoniae, S. aureus, H. influenzae

 Dinti: Bacteroides
 Cai lacrimale: S. aureus, S. pneumoniae,
H. influenzae, S. pyogenes

 Piele: S. aureus, S. pyogenes

FIZIOPATOLOGIE

 Edemul mucoasei
sinusale
 Scaderea drenajului
sinusal
 X microflorei sinus/
tract respirator sup.
 Proces supurativ
 Strabate peretii orbitei
 FIZIOPATOLOGIE

 Raport cu s. cavernoase
 Drenajul venos a 1/3
mediala fata+ sinusuri
paranazale→ v. orbitare
! Absenta valvelor

 Septurile intermusculare
 MORFOPATOLOGIC
 Tesutul grasos retrobulbar- infiltrat PMN
- edem inflamator
 CLINIC
 Debut: brusc, unilateral
 Semne si simptome:
Local - durere oculara spontan/
la mobilizare
- scaderea mobilitatii/
oftalmoplegie
- scadere AV/ diplopie
- proptoza axiala,
dureroasa, nereductibila
- edem palpebral
- eritemul pleoapelor
- chemosis conjunctval
 CLINIC
 Semne si simptome
General: - 38- 39oC
- frison
- cefalee
- greata
- varsaturi
- prostratie, torpoare
- rhinoree/ secretii nazale purulente
 EXAMENE PARACLINICE
 F.O.:- greu vizualizat, ingrosare venoasa
nevrita optica
 Ex. de laborator: -Leucocite 10000- 15000/mm3
-VSH crescut
 Rx. sinusala: 70% sinuzita( frontala/ etmoidala/
maxilara)
 ECHO( modul B)- hiperechogenitate
 CT- orbita: c. orbitara – c. preseptala
ASPECTE CT/RMN
 EXAMENE PARACLINICE
 Hemocultura
 Culturi din secretiile nazale
 Ex. ORL/ Stomatologic
 Punctie lombara
 DIAGNOSTIC DIFERENTIAL
 Celulita preseptala
 Disfunctii endocrine
(tireotoxicoze- b. Graves)
 T. sinus cavernos
 Fistula C-C
 Fungi( Mucormicoze,
Aspergiloze)
 Inflamatii idiopatice( miozita
orbitala, sarcoidoza, g.
Wegener, pseudotumori)
 Tumori( retionblastom, l.
Burkitt, c. metastatice)
 COMPLICATII
 Locale:- abces/ flegmon orbitar
- uveite septice
- nevrita optica
- obstructie ACR
- panoftalmie
 La distanta:- tromboflebita sinus cavernos
- abces cerebral
- meningita
 TRATAMENT
 Medical
Antibiotice: 10- 14 zile; iv/oral
Nafcilina( Stafilococi, Streptococi)+
Cefotaxime( Gram-)- 1-2g iv la 4 ore
Metronidazol( anaerobi) 7,5 mg/8 ore)
sau Ticarcilina- Clavulanat
sau Nafcilina- Ceftazidim
sau Nafcilina( 500mg- 1g iv la 4- 6 ore)- Cloramfenicol
(50mg/kgc/zi iv la 6 ore)
Alergie la beta lactamine: vancomicina 2g/6 ore
 TRATAMENT
 Diuretice- Acetazolamida( glaucom
secundar)
 Decongestive nazale( Fenilefrina)
 Antifungice
 Vaccin antitetanic
 TRATAMENT
 Chirurgical - la 48- 72 ore de la tratamentul Ab
simptomele nu se remit/amelioreaza
- scaderea AV
- progresia exoftamiei
- CT- sinusuri complet opacifiate
- Drenaj chirurgical al abceselor
- Drenaj chirurgical al sinusurilor, trepanatie,
sinusotomii
 PROGNOSTIC
 Tratament prompt
 Rezolvarea cauzelor
 Bun
 BIBLIOGRAFIE
 Paul Cernea- Tratat de Oftalmologie- Editura Medicala,
Bucuresti 2002
 M. Olteanu- Tratat de Oftalmologie, Editura Medicala, Bucuresti
1989
 M. Yanoff, J.S.Duker- Ophthalmology- 2nd edition, 2004
 J.Kansky- Clinical Ophthalmology, 5th edition, 2003
 S.J. Miller- Parson’s Diseases of the Eye, 18th edition
 J.N.Harrington- Orbital Cellulitis/nov. 2005/www.eMedicine.com
 Claudia Kirsch, UCLA, Roger Turbin, University of Medicine and
Dentistry- New Jersey, Orbit Infection( www.eMedicine.com)
 Judy Liu, University of Iowa, Young H. Kwon- Seton Infection:
Seratia Marcescenspatient with 1 day history of redness,
swelling and pain in the right eye