RIGHT ORBITAL CELLULITIS REVEALING A BRAIN ABSCESS: A CASE REPORT.

Orbital cellulitis is an inflammation of the orbital and periorbital cell tissues, often secondary to a periocular bacterial infection.

Two types of cellulitis are to be distinguished: preseptal cellulitis in front of the orbital septum and retroseptal cellulitis or “true” orbital infection behind the orbital septum.

It is a serious pathology that can involve both visual and vital prognosis.

The purpose of our observation is to emphasize the value of early diagnosis and the urgent performance of imaging (computed tomography CT).

 

A 19-year-old patient, who presented 10 days before hes hospitalization, diffuse headache, right periorbital pain preceding the onset of right orbital swelling, all progressing in a feverish context.

Ophthalmological examination:

Visual acuity 8/10 in the right eye; 10/10 in left eye.

In the right eye:

An inflammatory swelling of the upper eyelid, red hot painful and renitant.

The inflammation is spread to the lower eyelid.

Examination of the left eye: normal.

Neurological examination: no sign of localization.

Orbito-cerebral computed tomography:

Right supero-internal intra-orbital abscess extended to the upper eyelid.

Right frontal brain abscess exerting a mass effect.

Biology :

An inflammatory syndrome.

A puncture evacuating the eyelid abscess (was sterile).

The patient was hospitalized in the neurosurgery department for additional management: the evolution was satisfactory.

Orbital cellulitis = common cause of acute inflammation of the orbit.

The infectious invasion of the orbit is either hematogenous (sepsis) or by contiguity.

In contiguous orbital invasion, the sinus origin is involved in at least two-thirds of orbital cellulitis in adults and in 90% of cellulitis in children.

Its development is unpredictable. It can lead to local complications (subperiosteal abscess, intraorbital abscess, optic neuritis and atrophy, blindness), intracranial (brain abscess, sub and extradural empyema, cavernous sinus thrombosis) and sometimes death.

Computed tomography allows an accurate assessment of intra-orbital, bone and sinus lesions and intracranial complications.

Treatment is medical with adequate antibiotic therapy; surgery is only necessary in case of abscess or intracranial suppurative collection.

The prognosis is generally favorable for rapid and appropriate treatment.

Orbital cellulitis = diagnostic and therapeutic emergency.

It is important that it is recognized early and treated vigorously.

It is always a possible cause of blindness, even of death in the event of complication (s). 

Orbito-cerebral computed tomography is an essential diagnostic test.