CASE REPORT : ORBITAL CELLULITIS IN OLD PATIENT WITH HISTORY OF OCULAR INTERVENTION

Dr. Fatima al.mulhim 1 , Dr .Anoud al-jamaan 1 , Dr.kauser 2 , Dr.Abdulmohsin al-mulhim 3 , Dr.Muslem Albesher 1 , Hussain Al-Sinni 4 , Dr. Eman Al kishi 1 and Dr. Ahmed Al-esmael 3 . 1. Ophthalmology Resident , Aljaber Eye And ENT Hospital, Kingdom Of Saudi Arabia. 2. Ophthalmology Specialist, Aljaber Eye And ENT Hospital, Kingdom Of Saudi Arabia. 3. ER Resident, King Fahd Hospital, Kingdom Of Saudi Arabia. 4. ENT Resident, Aljaber Eye And ENT Hospital, Kingdom Of Saudi Arabia. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

Orbital cellulitis is considered as an ocular emergency which needs urgent evaluation and proper quick action to save the patient vision or even life The aim of this report is to present a case about orbital cellulitis with the presence of multiple risk factors as sinusitis and ocular intervention and how to approach such patients Copy Right, IJAR, 2017,. All rights reserved.

…………………………………………………………………………………………………….... Introduction:-
Orbital cellulitis is an inflammation of the soft tissues of the eye socket posterior the orbital septum,It most commonly occurs when bacterial infection spreads the adjacent paranasal sinuses or other nearby structures such as the face , eyelids or the lacrimal drainage system through the blood streamAlso , It can be caused by a direct trauma to the orbit ,in which traumas may introduce an infectious materials into the orbitother causes were reported such as direct inoculation of the orbit from surgery or Hematogenous spread from bacteremiaOrbital cellulitis is an ocular emergency that not only threatens vision but also can lead to life-threatening complications if left untrated such as cavernous sinus thrombosis, meningitis, and brain abscess.'Careful history taking and physical examination must be done for fast disease recognition and proper management Case Report:-86 years old Female presented to our hospital ER , complaining of right eye Pain , Redness and Swelling of the eyelid for 3 daysIt was gradual in onset , Progressed rapidly within these 3 days with significant decrease of vision .
Regarding her Past history the patient is Known hypertensive for long time on antihypertensive medication with regular follow ups in PHC .
Also ,she reported History of chronic arthritis .
Regarding her Past ocular history , she was diagnosed with nasolacrimal duct obstruction in a previous visit and She underwent right syringing probing in our hospital 5 days prior to the admission .

ISSN: 2320-5407
Int. J. Adv. Res. 5(2), 1465-1468 1466 The patients Clinical findings were as follows:-Her Vision in the Right Eye was counting fingers at 2 METERS and the left eye 0.5 both without correction Intraocular pressure was normal in both eyesRight eye examination revealed Upper and lower eyelid tender swelling along with conjunctival congestion and Chemosis.
There was also Non axial proptosis pushing the globe slightly outward and downwards with restriction of ocular movements in all directions .
On slit lamb Anterior segment examination:-Right Eye:-There was Grade 1 RAPD Immature cataract CT Scan without contrast revealed sub-periosteal abscess in the upper medial wall of the orbit originating from the ethmoid sinus which showed signs of sinusitis

Discussion:-
Displacement of the globe may be due to an increase in the orbital contents. the orbit has rigid bony walls except its anterior wall , such displacement usually manifests predominantly as forward protrusion of the globe which is called proptosis , which is the hallmark of orbital disease. orbital cellulitis may due to an injury perforating the orbital septum.
The Inflammation process can be noticed within the first 48-72 hours after injury, it may be delayed for several months if retained orbital foreign body.
Some orbital cellulitis cases were reported after surgical procedures, such as orbital decompression, DCR, blepharoplasty, squint surgeries, retinal surgery, and glaucoma surgery.
The diagnosis of orbital cellulitis is usually based on clinical findings with the aid of radiological findings sometimes Usually , The presence of orbital signs such as proptosis, pain during eye movements , ophthalmoloplegia, optic nerve involvement as well as fever and high WBC count confirm the diagnosis.Age, medical history , the presence of trauma and the mechanism of injury play an important role in determining the causative organism of orbital disease.Staphylococcus species, Streptococcus species and Bacteroides species are the most common organisms detected in adult orbital cellulitis , while unvaccinated children can present with sequelae from Haemophilusinfluenzae. To be noticed , some organisms can be detected In all age groups with specific conditions , foe example , dental abscess with mixed, aggressive aerobic and/or anaerobic infection must be considered if a suggestive history is elicited. Gram-negative rods are likely to be the causative organism recovered in abscesses