Odontogenic orbital cellulitis. Case report and review of literature

Abstract

Orbital cellulitis, a relatively infrequent infection of the ocular adnexa and orbital adipose tissue, is an ophthalmic emergency. In the absence of prompt anti-infective treatment, the spread of the infectious process can quickly lead to serious complications: vision loss, cavernous sinus thrombophlebitis, meningitis, intracranial septic spreads, and even death. In the adult population, the frequency of orbital complications from sinus infection ranges from 0.5% to 3.9%, and that of odontogenic orbital inflammation is even more infrequent. We report the case of a 56-year-old female patient with type 2 diabetes admitted in emergency for left exophthalmos, with painful limitation of eye movements and blurred vision in her left eye (LE). Fundus examination revealed in the LE significant optic disc edema, flame-shaped peripapillary hemorrhages, and dilated tortuous retinal veins. Due to the relative subacute course of proptosis and the mild orbital inflammatory signs, the diagnostic challenge was to differentiate between orbital cellulitis and a pseudo inflammatory sign that could be associated to an orbital lymphoma or other malignancies. Imaging findings were suggestive of odontogenic orbital cellulitis. A prompt intravenous antibiotic therapy was initiated, followed by ENT surgery of the infected tooth and maxillary sinusitis. The outcome was favorable, with progressive recovery of visual function. Conclusion: Odontogenic orbital cellulitis is an ocular emergency that is best managed by a multidisciplinary team consisting of an ophthalmologist, otolaryngologist, infectious diseases specialist and neurosurgeon. Prompt multimodal therapeutic approach, including imaging investigations, antibiotic therapy, and surgical treatment can avoid serious complications and lead to full recovery.