orbital abscess
Introduction
Introduction to eyelid abscess Orbital abscess (orbitalabscess) is an inflammatory reaction. Necrotic tissue and pyogenic bacteria accumulate in the sputum fat to form an abscess. Most of the abscess is located in the muscle cone and a few are located outside the muscle cone. The inflammatory response of the abscess and surrounding tissue causes severe damage to the eyelids and eye structures. basic knowledge The proportion of the disease: the incidence of the disease in a specific group is 0.05% - 0.09% Susceptible people: no special people Mode of infection: non-infectious Complications: headache
Cause
Cause of eyelid abscess
(1) Causes of the disease
Eyelid abscess is usually caused by bacterial infection, and idiopathic is extremely rare. Infection can enter the sputum through three ways:
1 direct spread of infection in adjacent tissues;
2 bacteria pass the blood circulation to reach the eyelids;
3 trauma, foreign bodies remain in the sputum, sinus, especially the ethmoid sinus and maxillary sinus infection caused by eyelid abscess is more common, can also be caused by incomplete treatment of sputum cellulitis, the majority of pus culture in the abscess is Staphylococcus aureus, Streptococcus, Haemophilus influenzae, diphtheria-like and anaerobic bacteria, and the diseases associated with it are as follows:
1. ethmoid sinusitis, maxillary sinusitis, frontal sinusitis, tooth or gum infection.
2. Trauma, penetrating injury, wood or plant foreign body, blunt contusion caused sinus wall fracture with infection.
3. Skin acne, abscess and eczema, scalp infection, nasal vestibular infection.
4. Influenza, subacute bacterial endocarditis, scarlet fever, vaccinia, herpes simplex, herpes zoster.
(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 abscess prevention
Pay attention to living habits and find timely treatment in time.
Complication
Eyelid abscess complications Complications
Ephedra, hyperopic diopter increased, single eye blindness, cyst, headache.
Symptom
Eyelid abscess symptoms Common symptoms Visual impairment Corneal abscesses keratitis Eye swelling Corneal ulcers IOP increased septic thrombus eyeballs
The patient may have elevated body temperature, dizziness, headache, severe illness, unconsciousness, elevated white blood cells in the surrounding blood, and left nucleus.
Suffering from eye pain, eyelid swelling is particularly obvious, local temperature rises, tenderness, mechanical ptosis of the upper palate, small cleft palate, and even disappear.
Conjunctival congestion and edema, severe conjunctival prominent in the cleft palate, resulting in eyelids can not be closed, resulting in exposed keratitis, corneal ulcer, eyeball protrusion, limited mobility or even eyeball fixation, due to inflammatory edema of the orbital tissue, increased pressure, Caused by retinal central venous return obstruction or central artery occlusion, may also produce septic optic neuritis, supply septic septic thrombosis of the retina, choroid and optic nerve, resulting in severe visual impairment or even blindness, advanced cases, pus along the eyeball and sputum The gap between the walls passes through the conjunctiva and flows out.
Examine
Examination of eyelid abscess
Laboratory inspection:
1. Intra-orbital puncture for bacterial culture of pus and simultaneous drug sensitivity test.
2. Pathological examination: The pathological changes of the orbital tissue of acute sputum abscess are similar to the pathological changes of cellulitis, ie tissue edema and polymorphonuclear leukocyte infiltration. Necrotic tissue exudate and septic bacteria form pus, at this time the pus wall is not obvious; the wall of chronic sputum abscess is fibrous connective tissue with lymphocytes, plasma cell infiltration, and a few abscess wall calcification.
Other auxiliary inspections:
1. Ultrasonic exploration: Type A ultrasound shows one or more hypoechoic waves or liquid leveling posterior boundary wave high points after high echo in the sac. B-mode ultrasound is shown in the strong echo group of the posterior fat pad, and one or more hypoechoic regions or non-echo zones appear in the absence of anechoic regions. The shape is irregular, the border is clear or unclear, indicating the severity of inflammation around the wall of the abscess. The larger anechoic area behind the ball can deform the eyeball under pressure. Color Doppler ultrasound showed abundant color blood flow in the fat and in the cyst wall due to inflammation, and there was no blood flow signal in the echo-free region.
2. CT scan: In the sputum, a circular or irregular high-density ring shadow is seen. The boundary clear can be accompanied by increased peripheral fat density, thickening of the eye wall, and the extraocular muscle is obscured or the optic nerve is thickened. The density of the sinus is increased, the mucosa is thickened, and the liquid level is sometimes seen, indicating that the abscess is secondary to sinusitis. CT can also find the location of foreign bodies, especially metal foreign bodies, and plant foreign bodies often show low density.
3. MRI: The position and shape of the abscess and sinusitis in the sinus are clearer than that of the CT. The pus contains more necrotic components and the T1WI is high signal intensity. T2WI showed a higher signal intensity due to more water in the pus. When the fibrous tissue of the abscess wall is thick, both T1WI and T2WI have low signals, which can confirm the formation of MRI on the abscess. The display of plant foreign body is obviously high. The signal is low or no signal in the background of foreign matter.
Diagnosis
Diagnosis and differentiation of orbital abscess
diagnosis
The diagnosis can be determined based on clinical manifestations combined with the results of the auxiliary examination.
Differential diagnosis
1. Orbital schwannomas: When the eyelid abscess is limited and the acute inflammatory symptoms of the eye and system are not obvious, it needs to be identified. The course of schwannoma is progressive, a process of gradual aggravation, and no history of inflammatory disease. Ultrasound exploration is mostly a solid lesion, and the internal echo is more or less, and it can be lobulated or cystic. CT images are not accompanied by changes in sinus inflammation, and the lesions can be fortified with a fortifier. Careful examination of medical history and pathological processes often helps in differential diagnosis.
2, orbital malignant tumors: children with orbital abscess and rhabdomyosarcoma, green tumors, etc. to identify. Adults are differentiated from malignant lymphoma and metastatic cancer.
Malignant lymphoma often occurs in middle-aged and elderly people, and is more common in the lacrimal gland. Short course of the disease, eyelid edema, ptosis, obvious edema of the conjunctiva, prominent eyeballs, eye movement disorders, decreased vision. The area touched the mass. Clinical symptoms are similar to sputum abscesses. Ultrasonic exploration showed irregular shape occupying lesions in the iliac crest, with less internal echo and incompressibility. The abscess is a cystic lesion that can be compressed. CT shows that the lymphoma is high-density and can be strengthened to distinguish it from the abscess.
