Orbital complications of acute rhinosinusitis: a study on clinical profile, surgical management and outcome

Objectives

1. Evaluate the clinical signs and their correlation to Computed Tomography(CT) findings

2. Assess the correlation between CT and intra-operative findings.

3. To identify implicated micro-organisms.

4. Evaluate the current practice in surgical management.

Methodology

A descriptive retrospective study conducted at Lady Ridgeway Hospital (LRH) on 19 patients who underwent endoscopic sinus surgery, drainage of pus and orbital decompression for radiologically suspected orbital complications of acute rhinosinusitis from 01/01/2015 to 31/12/2018.

Results

Clinical features were fever (73.7%), peri-orbital swelling (100%), chemosis(68.4%), proptosis(57.9%) and ophthalmoplegia(42.1%). Chemosis and ophthalmoplegia were found in 62% and 37% of the patients with intra-orbital abscesses, with only chemosis showing a statistically significant association.

CT was suggestive of subperiosteal abscess or inflammation in all. Intra-operatively abscesses were found in 16 (84.2%). Of these 6 had both subperiosteal and intra-orbital abscesses. Eight had subperiosteal abscesses. Two had only intra-orbital abscesses. The CT scan failed to predict the presence of abscess within the orbital fat in 3 out of 8. The positive predictive value was 89.4% for CT to detect orbital abscesses. An Intra-operative bony defect was noted in 15.8%. The mean surgery duration was 2.04 hours. Cultures revealed MRSA(21.1%), MSSA(15.8%), Pseudomonas(10.5%), mixed growth(10.6%) and Streptococcus viridans(5.3%).

Conclusion

The commonest presentations were peri-orbital swelling, fever, chemosis. MRSA and pseudomonas being the commonest organism, the appropriate empirical therapy needs further discussion. Endoscopic surgery is safe, reliable and cosmetic. As patients with intra-orbital abscesses may not be detected clinically or radiologically, we recommend routine incision of the orbital periosteum for suspected orbital complications of acute rhinosinusitis when undergoing endoscopic surgery.