orbital cellulitis
Introduction
Introduction to eyelid cellulitis Orbital cellulitis is an acute suppurative inflammation that occurs in the soft tissues of the eyelids. It is often considered a critical illness because it can cause permanent vision loss and is life-threatening through intracranial spread or sepsis. Can occur at any age and is more common in children. basic knowledge The proportion of illness: 0.13% Susceptible people: no special people Mode of infection: non-infectious Complications: eyelid abscess meningitis brain abscess optic neuritis
Cause
Causes of orbital cellulitis
(1) Causes of the disease
The disease is caused by a purulent bacterial infection, Staphylococcus aureus causes suppurative inflammation; Influenza bacilli cause non-suppurative inflammation; Anaerobic streptococcus is a common aerogenic bacterium; Proteus and Escherichia coli are systemic weakness and immune function Common pathogens of cellulitis in patients with low incidence, the infection routes are:
1. The most common form of inflammation around the sputum is 60% to 84% of all cases, mainly due to sinus inflammation invading the anterior sacral tissue. The ethmoid plate is very thin, 0.2 to 0.4 mm, and has blood vessels and nerves passing through. Therefore, ethmoid sinus inflammation easily spread into the sputum, followed by frontal sinus, maxillary sinus and sphenoid sinus inflammation; periodontitis and apical inflammation caused by maxillary sinus anterior wall abscess, upward wave and eyelid; embolic phlebitis through the venous plexus into the eyelid; Facial and eyelid swelling, erysipelas treatment does not prompt inflammation spread to the soft tissue before the septum; acute dacryocystitis spread to the eyelids.
2. Trauma directly infected with eyelids and penetrating wounds, improper wound treatment, direct infection of suppurative bacteria, formation of cellulitis, eyelid foreign bodies not taken out in time, especially plant foreign bodies, carrying bacteria, easy to cause infection, and may be accompanied by fistula When the fistula is occluded, the cellulitis is onset and the fistula can be temporarily improved when it is drained.
3. The blood is infected with other parts of the body, and the purulent lesions migrate to the eyelids through blood, or the eyelids simultaneously develop inflammation during sepsis.
4. Other eye muscle surgery; retinal detachment or external compression surgery; fasciitis to sputum fat spread; bacterial endophthalmitis spread; intraocular tumor necrosis and extensive Coat's disease secondary to peribulous inflammation; Patients with sexual immunodeficiency syndrome are associated with orbital cellulitis.
(two) pathogenesis
Pathogens are brought into the eyelids, continue to multiply, produce harmful substances, cause small blood vessels and telangiectasia, increase permeability of the wall, exudation of intravascular fluids and cellular components, tissue edema, neutrophil infiltration, manifested as Local redness, swelling, heat, pain and inflammation symptoms, pathogens can be seen in the lesions, leukocytes eventually disintegrate, release proteolytic enzymes, local tissue necrosis, dissolution, formation of abscesses, granulation formed by new capillaries and fibroblasts The tissue constitutes the wall of the abscess, and the granulation tissue is continuously formed in the wall, and finally the scar tissue is formed.
Prevention
Eyelid cellulitis prevention
Prevent trauma and treat systemic inflammation in a timely manner. Keep your mood comfortable and avoid excessive mood swings. The main predisposing factors for glaucoma are long-term bad mental stimulation, temper, depression, anxiety, and panic.
Complication
Eyelid cellulitis complications Complications, eyelid abscess, meningitis, brain abscess, optic neuritis
Septic cavernous sinus thrombopharyngitis (septic cavernous sinusthrombophlebitis) is inflammation caused by purulent pathogens or toxins in cellulitis entering the cavernous sinus along the ocular vein. The patient's temperature rises, severe deep eyelid pain, frontal pain and migraine , nausea, vomiting, severe ambiguity, eyelid edema, eyeball protrusion, and can cause contralateral eye, limited eye movement, fixed eyeball, decreased vision, even blindness, increased cells in cerebrospinal fluid, other complications such as Eyelid abscess, meningitis, brain abscess, epidural abscess, sacral osteomyelitis, exposed keratitis, optic neuritis, retina and choroidal necrosis.
Symptom
Eyelid cellulitis symptoms common symptoms nausea high fever eyeball keratitis optic atrophy convulsion meningitis coma
The deep systemic cellulitis is more severe than the anterior part of the sputum, especially in sepsis, cavernous sinus embolism, high fever, chills, meningeal irritation, and eye manifestations:
1. Painful eyelids and eyeball pain, tenderness is obvious, and the eyeball is aggravated when it is rotated.
2. edema eyelid congestion and edema, conjunctival edema prominent beyond the cleft palate, and visible conjunctival dry, erosion, necrosis.
3. The cornea is highly edematous due to the conjunctiva of the eyelid, the cleft palate can not be closed, and the cornea is exposed to cause keratitis, accounting for 21% to 25%.
4. The eyeball protrudes from the axial eyeball. When the contralateral eyeball is also prominent, attention should be paid to the presence of cavernous sinus embolism.
5. Vision loss tissue edema compression optic nerve or optic nerve involvement with optic neuritis, accounting for about 2%.
6. Ocular muscle eye movement disorders, mostly lack of movement in all directions, severe eyeball fixation.
7. Ocular edema of the fundus, retinal vein dilatation, retinal hemorrhage, retinal artery, venous obstruction, retinal detachment.
8. The pupillary pupillary conduction disorder is afferent reaction disorder, and direct light reflection disappears.
9. Unclear when combined with intracranial infection.
Examine
Eyelid cellulitis examination
1. Blood routine examination increased peripheral blood white blood cell count, and the proportion of neutrophil classification increased.
2. Histopathology The internal tissue specimens often show a large number of polymorphonuclear leukocyte infiltration, focal necrosis with or without sputum fat, if there is abscess formation, there is very obvious necrosis, Gram stain may reveal pathogenic bacteria Directly from the excised tissue or purulent material for bacterial culture, it is easier to find pathogenic bacteria.
3. The diagnostic value of X-ray is limited. The density of the orbital eyelid is higher than that of the contralateral side. It can show adjacent sinusitis. If osteomyelitis of the tibia is combined, the corresponding bone changes may occur.
4. Ultrasound (US) inspection BUS can show that the fat pad is enlarged after the ball, the echo of the fat body is uneven, the spot is sparse, and there is a crack between the eye wall and the posterior carotid body. If the inflammation involves the eye fascia, the eyeball can be displayed. The sound image of membranous changes.
5. CT Striped high-density shadow, as the lesion progresses, the normal interface of the sacral structure disappears, the density of the sputum is diffusely increased, and the eyeball is prominent. If there is adjacent sinusitis or foreign body, the source of inflammation may be displayed. The lesion may involve the intracranial and meningitis may occur. Subdural abscesses, enhanced CT scans, thickened meninges, and enhanced abscess walls are clearly shown.
6. MRI examination MRI horizontal axial scan can show the internal and external conditions in detail. Localized cellulitis can be displayed in the outer space of the muscle cone, and the soft tissue signal is displayed on the inner side of the ankle and the sinus. Long T2 signal with irregular edges can often show the presence of adjacent sinusitis. Diffuse cellulitis causes unclear structure in the sac, prominent eyeballs, and enhanced T1-weighted fat suppression can show diffuse enhancement of inflammatory tissue in the iliac The presence of different sizes does not strengthen the small abscess, and adjacent sinuses have an enhanced inflammation signal. Cellulitis can also cause supraorbital vein thrombophlebitis, and the fat signal in the affected side is longer than the contralateral side. Long T2 changes, cellulitis in the eyelids can also lead to complications such as intracranial meningitis, meningitis, and epidural abscess.
Diagnosis
Diagnosis and diagnosis of orbital cellulitis
diagnosis
Diagnosis can be made based on medical history, clinical manifestations, and examination.
In addition to ocular symptoms, the clinical manifestations of orbital cellulitis are acute, rapid, systemic, fever, and peripheral blood leukocyte counts. Childhood malignant tumors may have similar clinical manifestations and need to be identified.
Differential diagnosis
Cellulitis should be differentiated from childhood orbital malignancies, such as rhabdomyosarcoma, green tumors, etc.
1. Rhabdomyosarcoma (rhabdomyosarcoma) is the most common malignant tumor originating in the sputum in childhood. It has a high degree of malignancy, rapid development, high mortality, and some cases have a history of trauma. It is more common in children under 10 years of age. Subacute inflammation, poor general condition of the child, eye pain, eyelid congestion and edema, rapid development of the eyeball, more prominent forward and downward, due to tumor hemorrhage, necrosis, eyeball protrusion can suddenly increase, most cases can be seen in the rim Tumor, eye movement disorder, visual loss, optic disc and retinal edema visible in the fundus, ultrasound showed a lesion in the sacral cavity, clear border, irregular leading edge, low and few echoes in the tumor, widening of the fascia sac, optic disc edema The eyeball is deformed by pressure. CT shows soft tissue density in the sputum, irregular shape, unclear boundary, and normal peripheral blood examination.
2. Green tumor (chloroma) granulocyte leukemia directly infiltrates the tibia or soft tissue of the sputum to form a mass. The green tumor is also a malignant tumor with high incidence and high mortality in childhood. It is more common in children under 10 years of age. Fast, accompanied by low fever or nosebleeds, prominent eyeballs, conjunctival congestive edema, cleft palate can not be closed, exposed keratitis, eye movement disorders, systemic examination found liver, splenomegaly, can be found in other parts of the body, ultrasound and CT Can be found in the sacral lesions, peripheral blood examination see immature white blood cells, bone marrow puncture see a large number of immature granulocytes can be diagnosed.
3. Retinoblastoma (retinoblastoma) is the most common intraocular malignant tumor in childhood. It is more common in children under 5 years old. It is divided into intraocular phase, glaucoma phase, extraocular phase and metastasis phase 4, and its glaucoma phase and In the extraocular period, the child often has crying, general malaise, eyesight and tears, eyelid congestion and edema, cleft palate can not be closed, corneal ulcer, eyeball protrusion, eye movement disorder, etc., pay attention to the pupil pupil yellow-white, X-ray display The sacral cavity is enlarged, and the optic canal is enlarged. Ultrasound exploration shows that there is a solid mass in the vitreous cavity, the internal echo is different, the distribution is uneven, common calcium spot reflection and sound shadow, the optic nerve is thickened, and the extraocular phase can be seen in the iliac crest. There is an irregular echogenic area, which is continuous with the solid mass in the eye. CT has characteristic findings in the extraocular phase, and there are irregular calcium spots in the common tumor.
4. Xanthomatosis (Hand-Schüller-Christian syndrome) is a multifocal lesion, which is more common in children under 5 years of age. The clinical manifestations are characterized by skull destruction, ocular protrusion, and triad of diabetes insipidus. Fever, discomfort, malnutrition, swollen lymph nodes of the liver and spleen, the eyeball protrudes forward and downward, the vision is decreased, the eyeball is fixed, the ptosis is drooping, and the X-ray examination reveals a multi-focal osteolytic change of the flat bone, which is a map-like, CT common sputum Wall bone destruction, soft tissue occupying lesions.
Adult sputum cellulitis needs to be differentiated from orbital malignant tumors and inflammatory pseudotumors.
Orbital malignant tumors have a short course of disease, conjunctival congestion and edema of the eyelids, prominent eyeballs, eye movement disorders and decreased vision. Ultrasound shows a lesion in the sacral space, lacking sputum fat edema, CT shows sacral lesions, and bone destruction .
The onset of inflammatory pseudotumor needs to be differentiated from sputum cellulitis. The identification point is that the eye symptoms are not accompanied by fever and discomfort. Ultrasound exploration shows that the fascia edema and T-type sign can also show irregular lesions or extraoculars. Muscle, lacrimal gland enlargement, optic nerve thickening, etc. CT scan is superior to ultrasound, showing high-density mass in fat, irregular shape, uneven density, unclear boundary, thickening of eye wall, extraocular muscle hypertrophy, lacrimal gland Large, sputum cellulitis may have irregular high-density areas when there is abscess formation. The two need to be combined with clinical identification to distinguish from orthoparasites. If the worm body dies, the lytic layer causes inflammation and eyelid abscess. Look carefully for parasites during surgery.
