Orbital cellulitis

is inflammation of eye tissues behind the orbital septum. It most commonly refers to an acute spread of infection into the eye socket from either the adjacent sinuses or through the blood. It may also occur after trauma.

When it affects the rear of the eye, it is known as retro-orbital cellulitis.

It should not be confused with periorbital cellulitis, which refers to cellulitis anterior to the septum.

Common signs and symptoms of orbital cellulitis include pain with eye movement, sudden vision loss, chemosis, bulging of the infected eye, and limited eye movement. Along with these symptoms, patients typically have redness and swelling of the eyelid, pain, discharge, inability to open the eye, occasional fever and lethargy. It is usually caused by a previous sinusitis. Other causes include infection of nearby structures, trauma and previous surgery.

Periorbital cellulitis must be differentiated from orbital cellulitis, which is an emergency and requires intravenous (IV) antibiotics. In contrast to orbital cellulitis, patients with periorbital cellulitis do not have bulging of the eye (proptosis), limited eye movement (ophthalmoplegia), pain on eye movement, or loss of vision. If any of these features is present, one must assume that the patient has orbital cellulitis and begin treatment with IV antibiotics. CT scan may be done to delineate the extension of the infection.

Affected individuals may experience the following;

swelling,

redness,

discharge,

pain,

shut eye,

conjunctival injection,

fever (mild), slightly blurred vision, teary eyes, and some reduction in vision.

Typical signs include periorbital erythema, induration, tenderness and warmth.

The typical signs and symptoms of cellulitis is an area which is red, hot, and painful. The photos shown here of are of mild to moderate cases, and are not representative of earlier stages of the condition.

Cellulitis is caused by a type of bacteria entering the skin, usually by way of a cut, abrasion, or break in the skin. This break does not need to be visible. Group A "Streptococcus" and "Staphylococcus" are the most common of these bacteria, which are part of the normal flora of the skin, but normally cause no actual infection while on the skin's outer surface.

About 80% of cases of Ludwig's angina, or cellulitis of the submandibular space, are caused by dental infections. Mixed infections, due to both aerobes and anaerobes, are commonly associated with this type of cellulitis. Typically, this includes alpha-hemolytic streptococci, staphylococci, and bacteroides groups.

Predisposing conditions for cellulitis include insect or spider bite, blistering, animal bite, tattoos, pruritic (itchy) skin rash, recent surgery, athlete's foot, dry skin, eczema, injecting drugs (especially subcutaneous or intramuscular injection or where an attempted intravenous injection "misses" or blows the vein), pregnancy, diabetes, and obesity, which can affect circulation, as well as burns and boils, though debate exists as to whether minor foot lesions contribute. Occurrences of cellulitis may also be associated with the rare condition hidradenitis suppurativa or dissecting cellulitis.

The appearance of the skin assists a doctor in determining a diagnosis. A doctor may also suggest blood tests, a wound culture, or other tests to help rule out a blood clot deep in the veins of the legs. Cellulitis in the lower leg is characterized by signs and symptoms similar to those of a deep vein thrombosis, such as warmth, pain, and swelling (inflammation).

This reddened skin or rash may signal a deeper, more serious infection of the inner layers of skin. Once below the skin, the bacteria can spread rapidly, entering the lymph nodes and the bloodstream and spreading throughout the body. This can result in influenza-like symptoms with a high temperature and sweating or feeling very cold with shaking, as the sufferer cannot get warm.

In rare cases, the infection can spread to the deep layer of tissue called the fascial lining. Necrotizing fasciitis, also called by the media "flesh-eating bacteria", is an example of a deep-layer infection. It is a medical emergency.

"Staphylococcus aureus", "Streptococcus pneumoniae", other streptococci, and anaerobes are the most common causes, depending on the origin of the infection.

The advent of the "Haemophilus influenzae" vaccine has dramatically decreased the incidence.

Abscesses may occur in any kind of solid tissue but most frequently on skin surface (where they may be superficial pustules (boils) or deep skin abscesses), in the lungs, brain, teeth, kidneys, and tonsils. Major complications are spreading of the abscess material to adjacent or remote tissues, and extensive regional tissue death (gangrene).

The main symptoms and signs of a skin abscess are redness, heat, swelling, pain, and loss of function. There may also be high temperature (fever) and chills.

An internal abscess is more difficult to identify, but signs include pain in the affected area, a high temperature, and generally feeling unwell.

Internal abscesses rarely heal themselves, so prompt medical attention is indicated if such an abscess is suspected.

An abscess could potentially be fatal (although this is rare) if it compresses vital structures such as the trachea in the context of a deep neck abscess.

If superficial, abscesses may be fluctuant when palpated. This is a wave-like motion that is caused by movement of the pus inside the abscess.

Surgery of the anal fistula to drain an abscess treats the fistula and reduces likelihood of its recurrence and the need for repeated surgery. There is no evidence that fecal incontinence is a consequence of this surgery for abscess drainage.

Perianal abscesses can be seen in patients with for example inflammatory bowel disease (such as Crohn's disease) or diabetes. Often the abscess will start as an internal wound caused by ulceration, hard stool or penetrative objects with insufficient lubrication. This wound typically becomes infected as a result of the normal presence of feces in the rectal area, and then develops into an abscess. This often presents itself as a lump of tissue near the anus which grows larger and more painful with time. Like other abscesses, perianal abscesses may require prompt medical treatment, such as an incision and debridement or lancing.

Ludwig's angina is a fascial space infection with bilateral involvement of the submandibular, sublingual and submental spaces. The external signs may include bilateral lower facial edema around the mandible and upper neck. Intraoral signs may include a raised floor of mouth due to sublingual space involvement and posterior displacement of the tongue. Symptoms may include dysphagia, pain with swallowing, difficulty breathing, and pain.

Ludwig's angina should be treated urgently due to the airway being compromised. The infection may rapidly spread to other fascial spaces of the head and neck, further compromising the airway.

About 60 percent of initial attacks of dacryocystitis will recur. Individuals with a poorly functioning immune system (immunocompromised) may develop orbital cellulitis, which may lead to optic neuritis, proptosis, motility abnormalities, or blindness.

People usually complain of intense pain that may seem excessive given the external appearance of the skin. People initially have signs of inflammation, fever and a fast heart rate. With progression of the disease, often within hours, tissue becomes progressively swollen, the skin becomes discolored and develops blisters. Crepitus may be present and there may be a discharge of fluid, said to resemble "dish-water". Diarrhea and vomiting are also common symptoms.

In the early stages, signs of inflammation may not be apparent if the bacteria are deep within the tissue. If they are "not" deep, signs of inflammation, such as redness and swollen or hot skin, develop very quickly. Skin color may progress to violet, and blisters may form, with subsequent necrosis (death) of the subcutaneous tissues.

Furthermore, people with necrotizing fasciitis typically have a fever and appear sick. Mortality rates are as high as 73% if left untreated. Without surgery and medical assistance, such as antibiotics, the infection will rapidly progress and will eventually lead to death.

When it affects the groin it is known as Fournier gangrene.

The first symptom is a sudden onset of swelling of the face, which develops within two days into papules and pustues on the lips, nose, and around the eyes. These pustules release a purulent discharge, causing a crust to form on the skin. There is also lymphadenopathy (swelling of lymph nodes) in the main lymph nodes of the head. The feet, body, prepuce or perianal area may be affected. Pustular otitis externa can occur, with the pinnae (ear flaps) becoming thickened by edema. Affected areas are painful but not itchy. Approximately half of affected puppies have lethargy and depression. Less common symptoms include pyrexia, anorexia, and joint pain, caused by sterile suppurative arthritis.

Cutaneous group B streptococcal infection may result in orbital cellulitis or facial erysipelas in neonates.

This most common form of impetigo, also called nonbullous impetigo, most often begins as a red sore near the nose or mouth which soon breaks, leaking pus or fluid, and forms a honey-colored scab, followed by a red mark which heals without leaving a scar. Sores are not painful, but they may be itchy. Lymph nodes in the affected area may be swollen, but fever is rare. Touching or scratching the sores may easily spread the infection to other parts of the body.

Skin ulcers with redness and scarring also may result from scratching or abrading the skin.

Dacryocystitis is an infection of the lacrimal sac, secondary to obstruction of the nasolacrimal duct at the junction of lacrimal sac. The term derives from the Greek "dákryon" (tear), "cysta" (sac), and "-itis" (inflammation). It causes pain, redness, and swelling over the inner aspect of the lower eyelid and epiphora. When nasolacrimal duct obstruction is secondary to a congenital barrier it is referred to as dacrocystocele. It is most commonly caused by "Staphylococcus aureus" and "Streptococcus pneumoniae". The most common complication is corneal ulceration, frequently in association with "S. pneumoniae". The mainstays of treatment are oral antibiotics, warm compresses, and relief of nasolacrimal duct obstruction by dacryocystorhinostomy.

Ecthyma, the nonbullous form of impetigo, produces painful fluid- or pus-filled sores with redness of skin, usually on the arms and legs, become ulcers that penetrate deeper into the dermis. After they break open, they form hard, thick, gray-yellow scabs, which sometimes leave scars. Ecthyma may be accompanied by swollen lymph nodes in the affected area.

Boils are bumpy, red, pus-filled lumps around a hair follicle that are tender, warm, and very painful. They range from pea-sized to golf ball-sized. A yellow or white point at the center of the lump can be seen when the boil is ready to drain or discharge pus. In a severe infection, an individual may experience fever, swollen lymph nodes, and fatigue. A recurring boil is called chronic furunculosis. Skin infections tend to be recurrent in many patients and often spread to other family members. Systemic factors that lower resistance commonly are detectable, including: diabetes, obesity, and hematologic disorders. Boils can be caused by other skin conditions that cause the person to scratch and damage the skin.

Boils may appear on the buttocks or near the anus, the back, the neck, the stomach, the chest, the arms or legs, or even in the ear canal. Boils may also appear around the eye, where they are called styes. A boil on the gum is called intraoral dental sinus, or more commonly, a gumboil.

Ludwig's angina, otherwise known as angina ludovici, is a serious, potentially life-threatening cellulitis, or connective tissue infection, of the floor of the mouth, usually occurring in adults with concomitant dental infections and if left untreated, may obstruct the airways, necessitating tracheostomy. It is named after the German physician Wilhelm Friedrich von Ludwig who first described this condition in 1836. Other names include "angina Maligna" and "Morbus Strangularis".

Ludwig's angina should not be confused with "angina pectoris", which is also otherwise commonly known as ""angina"". The word ""angina"" comes from the Greek word ἀγχόνη "ankʰónē", meaning "strangling". In this case, Ludwig's angina refers to the feeling of strangling, not the feeling of chest pain, though there may be chest pain in Ludwig's angina if the infection spreads into the retrosternal space.

The life-threatening nature of this condition generally necessitates surgical management with involvement of critical care physicians such as those found in an intensive care unit.

Affected individuals typically develop symptoms including high fevers, shaking, chills, fatigue, headaches, vomiting, and general illness within 48 hours of the initial infection. The erythematous skin lesion enlarges rapidly and has a sharply demarcated, raised edge. It appears as a red, swollen, warm, and painful rash, similar in consistency to an orange peel. More severe infections can result in vesicles (pox or insect bite-like marks), blisters, and petechiae (small purple or red spots), with possible skin necrosis (death). Lymph nodes may be swollen, and lymphedema may occur. Occasionally, a red streak extending to the lymph node can be seen.

The infection may occur on any part of the skin, including the face, arms, fingers, legs, and toes; it tends to favour the extremities. Fat tissue and facial areas, typically around the eyes, ears, and cheeks, are most susceptible to infection. Repeated infection of the extremities can lead to chronic swelling (lymphangitis).

Aeromonas infections may cause skin infections manifesting as cellulitis, pustules, and furuncles. An infection usually only causes mild infections of the skin but can also cause a more a serious infection called gastroenteritis?

Tuberculous cellulitis is a skin condition resulting from infection with mycobacterium, and presenting as cellulitis.

A boil, also called a furuncle, is a deep folliculitis, infection of the hair follicle. It is most commonly caused by infection by the bacterium "Staphylococcus aureus", resulting in a painful swollen area on the skin caused by an accumulation of pus and dead tissue. Boils which are expanded are basically pus-filled nodules. Individual boils clustered together are called carbuncles.

Most human infections are caused by coagulase-positive "S. aureus" strains, notable for the bacteria's ability to produce coagulase, an enzyme that can clot blood. Almost any organ system can be infected by "S. aureus".

There are several paired paranasal sinuses, including the frontal, ethmoidal, maxillary and sphenoidal sinuses. The ethmoidal sinuses are further subdivided into anterior and posterior ethmoid sinuses, the division of which is defined as the basal of the middle turbinate. In addition to the severity of disease, discussed below, sinusitis can be classified by the sinus cavity which it affects:

- Maxillary – can cause pain or pressure in the maxillary (cheek) area ("e.g.," toothache, or headache) (J01.0/J32.0)

- Frontal – can cause pain or pressure in the frontal sinus cavity (located above eyes), headache, particularly in the forehead (J01.1/J32.1)

- Ethmoidal – can cause pain or pressure pain between/behind the eyes, the sides of the upper part of the nose (the medial canthi), and headaches (J01.2/J32.2)

- Sphenoidal – can cause pain or pressure behind the eyes, but often refers to the skull vertex (top of the head), over the mastoid processes, or the back of the head.

Anaerobes can be isolated from most types of upper respiratory tract and head and neck and infection and are especially common in chronic ones. These include tonsillar, peritonsillar and retropharyngeal abscesses, chronic otitis media, sinusitis and mastoiditis, eye ocular) infections, all deep neck space infections, parotitis, sialadenitis, thyroiditis, odontogenic infections, and postsurgical and nonsurgical head and neck wounds and abscesses., The predominant organisms are of oropharyngeal flora origin and include AGNB, "Fusobacterium" and Peptostreptococcus spp.

Anaerobes involve almost all dental infections. These include dental abscesses, endodontal pulpitis and periodontal (gingivitis and periodontitis) infections, and perimandibular space infection. Pulpitis can lead to abscess formation and eventually spread to the mandible and other neck spaces. In addition to strict anaerobic bacteria, microaerophilic streptococci and "Streptococcus salivarius" can also be present.

"Fusobacterium" spp. and anaerobic spirochetes are often the cause of acute necrotizing ulcerative gingivitis (or Vincent's angina) which is a distinct form of ulcerative gingivitis.

Deep neck infections that develop as a consequence of oral, dental and pharyngeal infections are generally polymicrobial in nature. These include extension of retropharyngeal cellulitis or abscess, mediastinitis following esophagus perforation, and dental or periodontal abscess.

The clinical presentation of CST can be varied. Both acute, fulminant disease and indolent, subacute presentations have been reported in the literature.

The most common signs of CST are related to anatomical structures affected within the cavernous sinus, notably cranial nerves III-VI, as well as symptoms resulting from impaired venous drainage from the orbit and eye.

Classic presentations are abrupt onset of unilateral periorbital edema, headache, photophobia, and bulging of the eye (proptosis).

Other common signs and symptoms include:

Ptosis, chemosis, cranial nerve palsies (III, IV, V, VI). Sixth nerve palsy is the most common. Sensory deficits of the ophthalmic and maxillary branch of the fifth nerve are common. Periorbital sensory loss and impaired corneal reflex may be noted. Papilledema, retinal hemorrhages, and decreased visual acuity and blindness may occur from venous congestion within the retina. Fever, tachycardia and sepsis may be present. Headache with nuchal rigidity may occur. Pupil may be dilated and sluggishly reactive. Infection can spread to contralateral cavernous sinus within 24–48 hours of initial presentation.