Subperiosteal orbital abscess is a purulent lesion of the orbital wall with inflammation of the paranasal sinuses. The disease is characterized by an acute onset, an increase in temperature to 39 ° C, swelling of the skin around the orbit, the development of conjunctival chemosis, the appearance of double vision, impaired eyeball movements, a sharp decrease in visual acuity. For diagnostics, visometry, biomicroscopy, tonometry, perimetry, radiography of the orbits and paranasal sinuses, ultrasound examination of the eye and orbit, CT or MRI of the orbits, paranasal sinuses and brain are used. Treatment is conservative (antibiotic therapy, detoxification therapy) and surgical (autopsy, drainage of the abscess).
H05.0 Acute inflammation of the eye socket
Subperiosteal orbital abscess is a purulent lesion of the orbit, in which inflammation of the orbital wall occurs with periosteal detachment against the background of bacterial infection in the sinuses of the nose. The orbit is a complex anatomical formation that supports the vital activity and function of the eye. The orbit has a close proximity to the paranasal sinuses and the cranial cavity, so a subperiosteal abscess of the orbit is a formidable disease in ophthalmology. Pathology, as a rule, proceeds in a severe form and has a high risk of developing blindness. The defeat is one-sided. It occurs more often in men than in women. Subperiosteal orbital abscess can occur at any age, the frequency of development does not depend on the country of residence.
Inflammatory diseases of the eye socket in most cases have a rhinosinusogenic origin. This is due to the anatomically close location of the orbit and paranasal sinuses. The upper wall of the eye socket is simultaneously the lower wall of the frontal sinus, and the lower wall of the eye socket is the upper wall of the maxillary sinus. In addition, the veins of the eyeball are devoid of valves, which leads to a wide relationship between the vessels of the face, nasal cavity, pterygoid region and cavernous sinus.
In pathogenesis, there are two variants of the spread of infection and the development of a subperiosteal abscess of the orbit. During the contact pathway, there is a consistent involvement of the mucous membrane of the paranasal sinuses, the connective tissue stroma and all layers of bone, which leads to the formation of an extensive lesion. The hematogenic pathway is characterized by the spread of infection through the perforant veins passing through the bone walls of the orbit, as well as through the branches of the upper orbital vein basin.
The causes of the development of subperiosteal abscess of the orbit include inflammatory processes in the paranasal sinuses, injuries to the facial skeleton and the presence of foreign bodies in the nasal sinuses. The most common infectious agents causing subperiosteal abscess of the orbit are streptococci, H. Influenzae, Moraxella catarrhalis. In addition, the causative agent of subperiosteal abscess of the orbit can be fungi of the genus Aspergillus, bacteroids, Pseudomonas infection, Hemophilus bacillus.
Clinical manifestations of subperiosteal abscess occur acutely. Common symptoms are characteristic: an increase in body temperature to 39-40 ° C, a pronounced intoxication syndrome, rigidity of the occipital muscles may be present. Local symptoms depend on the localization of the process. When the frontal sinus (frontal sinus) is affected, the process begins with the appearance of soreness and swelling of the skin of the forehead and upper eyelid at the inner edge of the eye. Conjunctival edema develops. There is a paresis of the oculomotor muscles, there is double vision. In the future, the swelling of the eyelid increases, the skin above it becomes tense, fluctuation appears. Visual acuity decreases sharply.
When the anterior and middle cells of the lattice labyrinth are affected, the symptoms are less pronounced. In the area of the inner edge of the orbit, soreness, hyperemia of the conjunctiva with the transition to dacryocystitis is determined. With the development of a subperiosteal abscess of the orbit in the zone of the maxillary sinus, redness and painful swelling of the lower eyelid, chemosis of the lower conjunctiva are observed. The defeat of the orbit with inflammation in the posterior cells of the lattice labyrinth and the sphenoidal sinus is manifested by severe soreness in the eye socket area with swelling of the eyelid skin. There is a displacement of the eyeball anteriorly and upward with a restriction of its mobility downwards. There is paralysis of the diverting and oculomotor nerves. Visual acuity decreases sharply. Complications include optic neuritis (up to atrophy), amaurosis (complete blindness of the eye), orbital phlegmon, meningitis, encephalitis, and cavernous sinus thrombosis.
Standard methods are used for diagnostics: visometry, biomicroscopy, tonometry, perimetry. To accurately determine the localization of the subperiosteal abscess of the orbit, radiation techniques are additionally used. Radiography of the orbits and paranasal sinuses in direct and lateral projections allows to diagnose a domed (exudative) detachment of the periosteum of the orbit and an increase in the densitometric density of the cellular tissue of the orbit around the focus of inflammation.
Ultrasound examination of the eye and orbit reveals a change in the size of the retrobulbar space, the course of the extraocular muscles. CT or MRI of the orbits, paranasal sinuses and brain helps to determine the detachment of the periosteum in the affected area. In addition, with a subperiosteal abscess of the orbit, consultation of an otolaryngologist, a maxillofacial surgeon and a neurosurgeon is required. Bacterial sowing of purulent discharge is carried out with the determination of sensitivity to antibacterial drugs.
Treatment of subperiosteal orbital abscess includes conservative and surgical techniques selected taking into account the characteristics of the primary focus of infection and the severity of the process. Conservative therapy includes the appointment of broad-spectrum antibacterial drugs. After determining the pathogen (obtaining the results of seeding of the separated), correction of treatment is required. Detoxification therapy is also carried out, the introduction of anticoagulants and proteolytic enzyme blockers is indicated for the prevention of thrombosis.
Medications are prescribed that restore the immune system and support the activity of various organs and systems of the body. Surgical treatment consists in opening, washing and draining the subperiosteal abscess of the orbit. The surgical technique is chosen depending on the location of the abscess. The operation is performed as soon as possible after the patient is admitted to the hospital. With timely treatment, the prognosis is favorable.
Preventive measures are aimed at preventing the development of a subperiosteal abscess. In the event of inflammatory diseases of the nasal cavity and paranasal sinuses, it is necessary to conduct a timely detailed examination by an otorhinolaryngologist with the appointment of competent drug therapy. To reduce injuries to the facial skeleton, safety precautions should be observed at work and at home. If symptoms of a subperiosteal orbit abscess appear, you need to consult a doctor as soon as possible to get qualified help.