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Full text of "Diseases Of The Nose Throat And Ear"

CHAPTER 15
COMPLICATIONS OF SINUSITIS

ORBITAL CELLULITIS AND ABSCESS

A spread of infection into the orbit may occur in acute sinusitis or more
commonly in acute exacerbations of chronic infection of the ethmoidal and
frontal sinuses. These sinuses are in close anatomical relationship with the
roof and the medial wall of the orbit, and infection may spread directly to
involve the orbital contents. There will be an orbital periostitis and a sub-
periosteal abscess formation leading to oedema of the eyelids, chemosis of the
conjunctiva and displacement of the eyeball with impairment of its mobility
(Fig. 36). If the spread occurs from the posterior ethmoidal cells there is

Fig. 36. Left orbital abscess secondary to suppura-
tion in the frontal sinus. Oedema of the left
upper eyelid, narrowing of the palpebral fissure,
proptosis with downward and lateral displacement
of left eyeball.

retrobulbar neuritis, optic atrophy and paralysis of the ocular muscles.
The infecting organisms are staphylococcus, streptococcus, including the
anaerobic type, pneumococcus and H* influenzae.

SYMPTOMS. The patient complains of pain around the orbit and of swelling
of the lids and the conjunctiva. Limitation of movement of the eyeball results
in diplopia, while pressure on the optic nerve may lead to optic atrophy and
blindness.

CLINICAL FEATURES. Swelling of the eyelids especially near the inner canthus
may be the first sign, followed by chemosis of the conjunctiva and limited eye
movements. Testing of visual acuity will show a central scotoma and a
peripheral contraction of the field of vision, especially for colours, and this
may be bilateral. Anterior rhinoscopy will show congested oedematous

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