Cavernous Sinus Thrombosis and Orbital Cellulitis

Background: Orbital complications of rhinosinusitis in adults are scarcely discussed in the literature. Objective: To review our experience with the management of orbital complications of rhinosinusitis in the adult patient population and identify key factors in the characteristics and management of these patients. Design: Retrospective case series during the years 2004 to 2016 in a tertiary referral center including all patients with rhinosinusitis and orbital complications. Main Outcomes and Measures: Severity of complications, risk factors, clinical, imaging and microbiological data, treatment outcomes. Results: Seventy patients were identified. Median age at diagnosis was 38 years. In 57%, complications were associated with acute rhinosinusitis and in 43% with chronic rhinosinusitis, most of whom had a history of previous sinus surgery. Thirty-five percent of patients received antibiotics prior to admission. The majority of the previously operated patients (61%) had some form of orbital wall dehiscence noted on imaging. Preseptal cellulitis was the most common complication (61.5%) encountered, followed by orbital cellulitis (23%), sub-periosteal abscess (11.5%), orbital abscess (3%), and cavernous sinus thrombosis (1.5%). Gram-positive bacteria were more commonly isolated from acute rhinosinusitis patients and gram-negative bacteria from chronic rhinosinusitis (CRS) patients. Complete recovery was noted in all patients, of whom 85% were managed conservatively. All, but 1 patient, with an abscess or cavernous sinus thrombosis required surgical drainage. Older age was the only risk factor identified for severe complications. Conclusions: In contrast to the pediatric population, CRS is very common in adults with orbital complications of rhinosinusitis, with previous sinus surgery and orbital wall dehiscence being noticeably common. Older patients are at risk for more severe complications. Conservative treatment suffices in patients with preseptal and orbital cellulitis. In more advanced stages, surgical drainage is advocated with excellent results. Larger cohort studies are needed to further investigate this patient group.

Download Full-text

Cavernous Sinus Thrombosis as Complications of Cellulitis Orbital: Case Report

International Journal of Research and Review ◽

10.52403/ijrr.20211032 ◽

2021 ◽

Vol 8 (10) ◽

pp. 248-251

Author(s):

Astari Arum Cendani Goller ◽

Kumara Tini

Keyword(s):

Cavernous Sinus ◽

Sinus Thrombosis ◽

Orbital Cellulitis ◽

High Morbidity ◽

Cavernous Sinus Thrombosis ◽

Blurred Vision ◽

The Face ◽

History Of ◽

Laboratory Investigations ◽

Visual Complaints

Background: Cavernous sinus thrombosis is a complication of infection around the face or paranasal sinuses with high morbidity and mortality rates. Cavernous sinus thrombosis is generally caused by septic infection, such as orbital cellulitis. Case Illustrations: A 35-year-old male who came to the neurology polyclinic complained of swelling in the left eyelid, red, watery eyes, blurred vision, difficulty opening the left eye, and the movement of the left eyeball felt normal. The patient had a history of left orbital cellulitis. Laboratory investigations showed an increase in inflammatory markers. The CT scan with contrast showed a hyperdense lesion in the left orbit, suggesting orbital cellulitis. The patient was diagnosed with a cavernous sinus thrombosis due to orbital cellulitis. He was treated with an antibiotic, anticoagulant, and corticosteroid. Three months after treatment, the visual complaints improved, the headache decreased drastically, and we did not find any extraocular muscles weakness. Conclusions: The administration of antibiotics and anticoagulant therapy in patients with cavernous sinus thrombosis has been proven clinically. The use of corticosteroids has not been proven but is strongly suspected to reduce edema caused by compression of the cavernous sinus. Keywords: Cavernous sinus thrombosis, orbital cellulitis. infections.

Download Full-text

Ophthalmic manifestations of SARS-CoV-2 (COVID-19)

Indian Journal of Clinical and Experimental Ophthalmology ◽

10.18231/j.ijceo.2021.060 ◽

2021 ◽

Vol 7 (2) ◽

pp. 293-301

Author(s):

Aastha Garg ◽

Sandhya Ramachandra

Keyword(s):

Cavernous Sinus ◽

Sinus Thrombosis ◽

Tertiary Care ◽

Orbital Cellulitis ◽

Care Hospital ◽

Cavernous Sinus Thrombosis ◽

Cross Sectional ◽

Systemic Involvement ◽

Ocular Manifestations ◽

Ophthalmic Manifestations

The world has been dealing with the pandemic of COVID-19 since December 2019. The systemic manifestations of the disease are well known. Our study aims to evaluate the ocular manifestations of SARS-CoV-2 (COVID-19). This cross-sectional observational study comprised of 60 subjects that tested positive for COVID-19 by RT-PCR, and admitted to the general wards of a tertiary care hospital of South India. Relevant medical history, ocular history, symptoms, signs and blood investigations data were obtained by communicating directly with the subjects and patient files. Ocular examination was done using diffuse torch light.15% patients presented with conjunctivitis in association with increased conjunctival secretion, tearing and burning sensation. 3.33% patients presented with dry eye disease and orbital cellulitis each. 1.67% patients developed epiphora, cavernous sinus thrombosis and orbital cellulitis with retinal detachment each. A statistically significant correlation was found between the provisional diagnosis and C-reactive protein (CRP) values.Conjunctival congestion can be one of the ocular symptoms of COVID-19. Asymptomatic COVID-19 patients may primarily present to an ophthalmologist with red eye, thus universal precautions must be taken while examining such cases. Evaluation of symptomatic patients with orbital cellulitis and cavernous sinus thrombosis can further aid in understanding the ophthalmic implications, pathogenesis and systemic involvement of this disease.

Download Full-text