Sunday, May 27, 2007

Preseptal and orbital cellulitis in a developing country

Preseptal and orbital cellulitis in a developing country
Orbit. 2007 Jan-Mar
Uy HS,
Tuano PM.
Sentro Oftalmologico Jose Rizal, Department of Ophthalmology, University of the Philippines - Philippine General Hospital. Manila. Philippines.

Purpose: To report the clinical features, etiology, management practices, and outcomes of preseptal (PC) and orbital cellulitis (OC) in a developing country.

Methods: The charts of all patients with PC and OC at the Philippine General Hospital from 1990 to 1995 were reviewed and the following data retrieved: age, gender, manner of presentation, causative agent, treatment, and outcomes.

Results: Of 91 patients, 56 (62%) were diagnosed with PC and 35 (38%) with OC. The mean age at presentation was 12.6 +/- 17.0 years and 17.1 +/- 18.6 years, respectively. No sex predilection was observed. Ophthalmoplegia, chemosis, pain, proptosis, and blurred vision were associated with OC. Eyelid infection was the most common antecedent factor and was present in 15 (27%) PC patients and 13 (37%) OC patients. Staphylococcus was the most frequent causative organism. Intravenous antibiotics were administered to 35 (62%) PC patients and all patients with OC. Surgical intervention was performed in 15 (27%) PC patients and 22 (63%) OC patients. None of the PC patients developed permanent sequelae. Seventeen (49%) OC patients developed serious complications such as: visual loss (29%), neurological deficits (17%), and mortality (3%).

Conclusions: In developing countries, eyelid infection may be the most important predisposing factor for periocular infection. Staphylococcus is the predominant causative agent. OC can be associated with serious complications. Aggressive management of OC may improve patient outcomes.

Keywords: Eyelid infection; orbital cellulitis; bacterial infections; microbiology; nasolacrimal duct obstruction; preseptal cellulitis; ophthalmoplegia; Staphylococcus; antibiotic therapy; underdeveloped countries; Philippines




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