Retrobulbar abscess


Retrobulbar abscess

Description, Causes and Risk Factors:

An abscess posterior to the globe of the eye.

Although retrobulbar abscess is common, its etiology is poorly understood and is not always confirmed. It is assumed to be a bacterial infection, either of hematogenous origin or due to penetrating injury from the oral cavity in association with a foreign body. Mixed flora or no growth is a common finding on aerobic bacterial culture, and in many cases anaerobic culture testing methods are required in order to demonstrate the organisms. Aspergillus spp. and Penicillium spp. have been isolated.

The process begins as orbital cellulites then localization occurs and an abscess may form. At the stage of cellulites, the clinical signs are less extreme; that is pain may be less, oral signs nonexistent, and diagnosis more difficult.

The prevalence of retrobulbar abscess is very rare.

Symptoms:

The most important clinical signs of retrobulbar abscess/cellulites are as follows:

    Exophthalmos.

  • Periorbital swelling.

  • Pain on opening of the mouth.

  • Fluctuating red swelling in the oral mucous membrane behind last upper molar.

  • Protrusion of the third eyelid.

  • Chemosis, which is usually unilateral.

  • Pyrexia.

  • Anorexia.

  • Leukocytosis.

Diagnosis:

Retrobulbar abscess must be distinguished from orbital cellulites, which has similar but less marked clinical signs. In orbital cellulites pain is less evident, pyrexia and anorexia are not as pronounced and less exudate or no exudate is present on orbital drainage. Orbital cellulites may progress to retrobulbar abscess. Retrobulbar abscess may be distinguished from other causes of exophthalmos on the basis of its acute onset, pain, and often pyrexia. Leukocytosis with neutrophilia may be present.

Treatment:

Orbital cellulites and retrobulbar abscess are treated similarly, as follows: Drainage via an incision is made through only the oral mucosa. A pair of curved Circle hemostats are a blunt probe is inserted and opened in small steps until the orbit is reached. Orbital tissues should not be crushed or cut during this process so as to avoid damage to the optic nerve or orbital vasculature. This technique allows pockets of exudate to be drained while limiting damage to the orbit. Considerable amounts of exudate under pressure may be released, and dependent drainage to the oral cavity is established. Although exudate is frequently not obtained, drainage is an important prerequisite step in treatment. Failure to locate exudate indicates that the process is still at lacrimal sac and protrusion of orbital fat must be distinguished from cysts because their appearance may be similar.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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