RESUMEN
OBJECTIVE: The present study revisited three classification systems of orbital complications of acute rhinosinusitis (ARS) (Chandler, Mortimore & Wormald, and Velasco e Cruz & Anselmo-Lima) and observed which of them presented the best clinical applicability. METHODS: Clinical data and CT scan findings of patients with orbital infection were retrospectively collected. To compare the three classification systems, we revised and graded all CT images accordingly, and divided the patients into four groups: Eyelid cellulitis (EC), orbital cellulitis (OC), subperiosteal abscess (SA), and orbital abscess (OA). The groups were compared regarding the presence of sinus opacification, the need for hospitalization and/or surgical treatment, and the presence of further complications/sequelae. RESULTS: 143 patients were included. The median number of sinuses involved in patients in the OC, SA, and OA groups was 2.0. ARS was rarely associated with signs of EC (present in both Chandler's and Mortimore & Wormald's classifications. The hospitalization rate was significantly lower in the EC group compared to the other three groups. Surgery was performed in all cases in the OA group, in 58.1% in the SA group, 19.4% in the OC group, and 12.5% in the EC group (p-valueâ¯<â¯0.0001). Complications were present at higher rates in the OA group compared to the other three groups. CONCLUSIONS: ARS was rarely associated with Eyelid Cellulitis. The stratification in the other three groups showed to be clinically relevant. Velasco e Cruz & Anselmo-Lima's classification system proved valid, simple, and effective for categorizing orbital complications of ARS.
Asunto(s)
Celulitis Orbitaria , Enfermedades Orbitales , Rinitis , Sinusitis , Humanos , Estudios Retrospectivos , Absceso/diagnóstico por imagen , Absceso/etiología , Rinitis/complicaciones , Rinitis/diagnóstico por imagen , Rinitis/cirugía , Celulitis Orbitaria/diagnóstico por imagen , Celulitis Orbitaria/etiología , Sinusitis/complicaciones , Sinusitis/diagnóstico por imagen , Sinusitis/cirugía , Enfermedad Aguda , Enfermedades Orbitales/etiología , Enfermedades Orbitales/complicacionesRESUMEN
Abstract Introduction: The standard management of orbital cellulitis is to administer a combination of intravenous broad-spectrum antibiotics along with treatment of associated sinusitis. Objective: The purpose of this study was to evaluate whether the addition of corticosteroids could lead to earlier resolution of inflammation and improve disease outcome. Methods: We independently searched five databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) for studies published as recent as December 2019. Of the included studies, we reviewed orbital cellulitis and disease morbidity through lengths of hospitalization, incidence of surgical drainage, periorbital edema, vision, levels or C-reactive protein, and serum WBC levels in order to focus on comparing steroid with antibiotics treated group and only antibiotics treated group. Results: Lengths of hospitalization after admission as diagnosed as orbital cellulitis (SMD = −4.02 [−7.93; −0.12], p -value = 0.04, I2 = 96.9%) decrease in steroid with antibiotics treated group compared to antibiotics only treated group. Incidence of surgical drainage (OR = 0.78 [0.27; 2.23], p -value = 0.64,I2 = 0.0%) was lower in the steroid with antibiotics treated group compared to the antibiotics only treated group. Conclusion: Use of systemic steroids as an adjunct to systemic antibiotic therapy for orbital cellulitis may decrease orbital inflammation with a low risk of exacerbating infection. Based on our analysis, we concluded that early use of steroids for a short period can help shorten hospitalization days and prevent inflammation progression.
Resumo Introdução: O tratamento padrão da celulite orbitária inicia-se com uma combinação de antibióticos intravenosos de amplo espectro concomitante ao tratamento do seio comprometido. Objetivos: O objetivo deste estudo foi avaliar se a adição de corticosteroides poderia levar a uma resolução mais precoce da inflamação e melhorar o desfecho da doença. Método: Fizemos uma pesquisa independente em cinco bancos de dados (PubMed, SCOPUS, Embase, Web of Science e o banco de dados Cochrane) em busca de estudos publicados até dezembro de 2019. Dos estudos incluídos, revisamos a celulite orbitária e a morbidade da doença através dos períodos de internação, incidência de drenagem cirúrgica, edema periorbital, visão, níveis de proteína C-reativa e níveis séricos de leucócitos com foco na comparação do grupo tratado com esteroides e antibióticos e do grupo tratado apenas com antibióticos. Resultados: Os tempos de internação após a admissão dos diagnosticados com celulite orbitária (SMD = -4,02 [-7,93; -0,12], p-valor = 0,04, I2 = 96,9%) diminuíram no grupo tratado com esteroides e antibióticos em comparação ao grupo tratado apenas com antibióticos. A incidência de drenagem cirúrgica (OR = 0,78 [0,27; 2,23], p-valor = 0,64, I2 =0,0%) foi menor no grupo tratado com esteroides e antibióticos em comparação com o grupo tratado apenas com antibióticos. Conclusão: O uso de esteroides sistêmicos como adjuvante da antibioticoterapia sistêmica para celulite orbitária pode diminuir a inflamação orbitária com baixo risco de agravar a infecção. Com base em nossa análise, concluímos que o uso precoce de esteroides por um curto período pode ajudar a encurtar os dias de internação e prevenir a progressão da inflamação.
Asunto(s)
Humanos , Enfermedades Orbitales/complicaciones , Enfermedades Orbitales/tratamiento farmacológico , Celulitis Orbitaria/diagnóstico , Celulitis Orbitaria/etiología , Celulitis Orbitaria/tratamiento farmacológico , Esteroides , Celulitis (Flemón)/complicaciones , Celulitis (Flemón)/tratamiento farmacológico , Estudios Retrospectivos , Corticoesteroides/uso terapéutico , Inflamación , Antibacterianos/uso terapéuticoRESUMEN
Introduction There are some inflammatory, infectious, and neoplastic diseases affecting the extrinsic orbital musculature (EOM) that present with pain, decreased visual acuity, and proptosis. Imaging is fundamental to the differential diagnoses of these diseases with similar clinical presentations. The present case series report has as main objective to illustrate and discuss the main pathologies that affect the orbit. Material and Methods The present series of cases discusses the main pathologies that can affect the extraocular musculature that can be characterized by computed tomography (CT) or magnetic resonance imaging (MRI) using cases from our institution. Results and Discussion The present study compiled several cases of ophthalmopathy from our institution to illustrate and address some of these pathologies, such as orbital lymphoma, Grave disease, metastases, periorbital cellulitis, and idiopathic orbital inflammatory syndrome. The diseases are discussed according to the presentation of clinical cases with emphasis on the main imaging findings of each pathology. Conclusion Computed tomography and MRI can help in the diagnosis and follow-up of the diseases that affect the EOM. We must be conversant with the main characteristics of the pathologies presented in the present case series report, since such findings together with clinical data can confirm the diagnosis of these diseases or at least help to narrow the differential diagnoses.
Asunto(s)
Sarcoidosis/diagnóstico por imagen , Neoplasias Orbitales/diagnóstico por imagen , Seudotumor Orbitario/diagnóstico por imagen , Oftalmopatía de Graves/diagnóstico por imagen , Celulitis Orbitaria/diagnóstico por imagen , Músculos Oculomotores/patología , Diagnóstico Diferencial , Celulitis Orbitaria/clasificación , Celulitis Orbitaria/etiología , Miositis Orbitaria/diagnóstico por imagen , Granuloma de Células Plasmáticas/diagnóstico por imagenRESUMEN
INTRODUCTION: The standard management of orbital cellulitis is to administer a combination of intravenous broad-spectrum antibiotics along with treatment of associated sinusitis. OBJECTIVE: The purpose of this study was to evaluate whether the addition of corticosteroids could lead to earlier resolution of inflammation and improve disease outcome. METHODS: We independently searched five databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) for studies published as recent as December 2019. Of the included studies, we reviewed orbital cellulitis and disease morbidity through lengths of hospitalization, incidence of surgical drainage, periorbital edema, vision, levels or C-reactive protein, and serum WBC levels in order to focus on comparing steroid with antibiotics treated group and only antibiotics treated group. RESULTS: Lengths of hospitalization after admission as diagnosed as orbital cellulitis (SMD=-4.02 [-7.93; -0.12], p-value=0.04, I2=96.9%) decrease in steroid with antibiotics treated group compared to antibiotics only treated group. Incidence of surgical drainage (OR=0.78 [0.27; 2.23], p-value=0.64, I2=0.0%) was lower in the steroid with antibiotics treated group compared to the antibiotics only treated group. CONCLUSION: Use of systemic steroids as an adjunct to systemic antibiotic therapy for orbital cellulitis may decrease orbital inflammation with a low risk of exacerbating infection. Based on our analysis, we concluded that early use of steroids for a short period can help shorten hospitalization days and prevent inflammation progression.
Asunto(s)
Celulitis Orbitaria , Enfermedades Orbitales , Corticoesteroides/uso terapéutico , Antibacterianos/uso terapéutico , Celulitis (Flemón)/complicaciones , Celulitis (Flemón)/tratamiento farmacológico , Humanos , Inflamación , Celulitis Orbitaria/diagnóstico , Celulitis Orbitaria/tratamiento farmacológico , Celulitis Orbitaria/etiología , Enfermedades Orbitales/complicaciones , Enfermedades Orbitales/tratamiento farmacológico , Estudios Retrospectivos , EsteroidesRESUMEN
Orbital infection is the most frequent complication of ethmoiditis. Recurrent periorbital cellulitis is a very rare complication of rhinosinusitis with only three reports in the literature describing this pathological process. This complication can be favored by an anatomical abnormality of the uncinate process or mucocele obstructing the normal drainage pathway, in addition to ethmoidal sinusitis. Computed tomography and magnetic resonance guide the diagnosis. The treatment is based on antibiotics, corticosteroids and local decongestants. Surgical treatment is indicated in the absence of response to treatment established after 48 hours or decrease in visual acuity or recurrent orbital complications without underlying tumor pathology. In this report, we present a case of orbital complication of rhinosinusitis in a 4 year-old-child with six episodes of unilateral periorbital cellulitis and one episode of subperiosteal orbital abscess since the age of 3 months. There was a complete resolution with no recurrence after the surgical intervention.
El compromiso orbitario es la complicación más frecuente de la rinosinusitis aguda en pediatría, y el etmoides es el seno más afectado. La recurrencia es infrecuente. Existen solo tres casos publicados en la literatura. Una anomalía anatómica del proceso unciforme o un mucocele podrían ser factores predisponentes, que pueden obstruir el drenaje normal de los senos junto con la presencia de etmoiditis. La tomografía computada y la resonancia magnética orientan el diagnóstico. El tratamiento quirúrgico está indicado ante la falta de respuesta al tratamiento instaurado luego de 48 horas o disminución de la agudeza visual o recurrencias sin patología tumoral de base. Se presenta a un paciente de 4 años de edad que consultó por un cuadro compatible con etmoiditis complicada recurrente. Presentó celulitis preseptal en seis oportunidades y un episodio de absceso subperióstico, desde los 3 meses de edad. Evolucionó favorablemente luego de la operación quirúrgica.
Asunto(s)
Sinusitis del Etmoides/complicaciones , Celulitis Orbitaria/etiología , Rinitis/complicaciones , Absceso/etiología , Absceso/cirugía , Preescolar , Sinusitis del Etmoides/cirugía , Humanos , Masculino , Celulitis Orbitaria/cirugía , Recurrencia , Rinitis/cirugíaRESUMEN
La celulitis orbitaria es la causa más frecuente de inflamación aguda de la órbita y constituye una urgencia oftalmológica relativamente frecuente y potencialmente grave en la población pediátrica. La inflamación puede extenderse a la región postseptal, y afectar el contenido de la órbita. La relación anatómica de la órbita con estructuras vecinas como los senos paranasales, es clave para entender la etiopatogenia de la enfermedad; aparece, en la mayoría de las ocasiones, como complicación de una sinusitis. Se presenta una paciente de cinco años de edad, con diagnóstico de celulitis orbitaria secundaria a una sinusitis. La descripción de las características clínicas de la enfermedad y su manejo en este caso, puede aportar información útil para el mejor abordaje de la entidad. Se concluye que los elementos fundamentales son el diagnóstico temprano y la atención multidisciplinaria.
Orbital cellulitis is the most frequent cause of acute swelling of the orbit and is a relatively frequent ophthalmological emergency and potentially serious in the pediatric population. The inflammation may extend to post septal region, and affect the orbit content. The anatomical relation of the orbit with their neighboring structures as paranasal sinuses is the key to understand the etiopathogenesis of the disease; a case of a five-year-old patient is presented, with a diagnosis of orbital cellulitis secondary to sinusitis. The description of the clinical characteristics of the disease and its management in this case, may offer useful information for a better approach of this entity. It is concluded that the main elements are early diagnosis and multidisciplinary evaluation.
Asunto(s)
Femenino , Preescolar , Sinusitis Frontal/complicaciones , Celulitis Orbitaria/diagnóstico , Celulitis Orbitaria/terapia , Celulitis Orbitaria/etiologíaRESUMEN
Here we report a case of childhood glaucoma refractory to angle and trabeculectomy surgery. The patient was treated with an Ahmed™ drainage implant that was subsequently complicated by rapid-onset panophthalmitis and orbital cellulitis. Intravenous and intravitreal antibiotic therapy was initiated and the drainage tube was removed. The infectious process resolved within 3 weeks; however, phthisis bulbi developed subsequently.
Asunto(s)
Implantes de Drenaje de Glaucoma/efectos adversos , Glaucoma/cirugía , Celulitis Orbitaria/etiología , Panoftalmitis/etiología , Antibacterianos/uso terapéutico , Remoción de Dispositivos , Glaucoma/congénito , Humanos , Lactante , Presión Intraocular , Masculino , Celulitis Orbitaria/tratamiento farmacológico , Panoftalmitis/tratamiento farmacológico , Complicaciones Posoperatorias , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus epidermidis/aislamiento & purificación , Resultado del TratamientoRESUMEN
ABSTRACT Here we report a case of childhood glaucoma refractory to angle and trabeculectomy surgery. The patient was treated with an Ahmed™ drainage implant that was subsequently complicated by rapid-onset panophthalmitis and orbital cellulitis. Intravenous and intravitreal antibiotic therapy was initiated and the drainage tube was removed. The infectious process resolved within 3 weeks; however, phthisis bulbi developed subsequently.
RESUMO Relato de um caso de uma criança portadora de glaucoma congênito primário, refratário a cirurgias angulares e trabeculectomias prévias, submetido à implante de drenagem do tipo Ahmed®. O paciente evoluiu com panoftalmite e celulite orbitária de aparecimento súbito, sendo submetido à remoção do tubo e antibioticoterapia endovenosa e intravítrea. O processo infeccioso foi resolvido em três semanas, porém o olho evoluiu para phthisis bulbi.
Asunto(s)
Humanos , Masculino , Lactante , Panoftalmitis/etiología , Glaucoma/cirugía , Implantes de Drenaje de Glaucoma/efectos adversos , Celulitis Orbitaria/etiología , Complicaciones Posoperatorias , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus epidermidis/aislamiento & purificación , Panoftalmitis/tratamiento farmacológico , Glaucoma/congénito , Resultado del Tratamiento , Remoción de Dispositivos , Celulitis Orbitaria/tratamiento farmacológico , Presión Intraocular , Antibacterianos/uso terapéuticoRESUMEN
Odontogenic abscess can become an orbital cellulitis, causing potentially serious intracranial and orbital complications. The full clinical complications from odontogenic orbital cellulitis in a pediatric patient are rarely seen daily in hospital emergency departments. Thus, odontogenic orbital cellulitis still remains a rarity, resulting in a medical challenge. With this in mind, this study aimed to describe a case of periorbital and orbital cellulitis resulting from odontogenic origin in a 6-year-old patient who was successfully treated by performing intravenous antibiotic administration combined with surgical drainage.
Asunto(s)
Infección Focal Dental/complicaciones , Celulitis Orbitaria/etiología , Antibacterianos/uso terapéutico , Niño , Terapia Combinada , Drenaje , Infección Focal Dental/terapia , Humanos , Imagenología Tridimensional , Masculino , Celulitis Orbitaria/terapia , Tomografía Computarizada por Rayos XRESUMEN
La celulitis orbitaria usualmente ocurre como complicación de infecciones de los senos para nasales, y la etiología es principalmente bacteriana. Para realizar un diagnóstico e implantar terapéutica temprana tiene gran importancia reconocer las manifestaciones clínicas de la sinusitis y las edades más afectadas, pues dada su ubicación anatómica, pueden complicarse también con infecciones del sistema nervioso central, que en la edad pediátrica tienen una connotación especial. Se presentan aquí dos pacientes de 10 y 14 años de edad respectivamente, que desarrollaron celulitis orbitaria en un caso, y celulitis frontal y empiema en el otro; así mismo, se muestran los medios diagnósticos utilizados para identificar signos tempranos de posibles complicaciones, con el objetivo que el pediatra pueda identificarlos, así como la terapéutica implantada para dar solución o evitar estas complicaciones(AU)
Orbital cellulite generally occurs as a complication of paranasal sinus infections and the etiology is mainly bacterial. It is very important to recognize the clinical manifestations of sinusitis and the most affected ages to make a correct diagnosis and to apply early treatment, since its anatomical location may bring complications with central nervous system infections which, at pediatric ages, can acquire special significance. Here are two patients aged 10 and 14 years, who developed orbital cellulitis in one case and frontal cellulitis and empyema in the other. Likewise, the diagnostic means used to identify the early signs of possible complications were presented, in order that a pediatrician can detect them, as well as the treatment to solve or to prevent these complications(AU)
Asunto(s)
Humanos , Adolescente , Sinusitis/complicaciones , Celulitis Orbitaria/etiología , Empiema/etiología , Sinusitis Frontal/etiología , Informes de CasosRESUMEN
BACKGROUND: Orbital infection is an uncommon devastating infection and is usually a complication of paranasal sinus infection. Without appropriate treatment, orbital infection may lead to serious complications, even death. Prompt treatment is mandatory to avoid visual loss or intracranial complications. The literature shows that initially, intravenous antibiotics should be administered, and after 48 h, if no improvement appears, the affected orbit and the sinuses must be surgically drained. The authors describe two cases of orbital cellulitis with a brief literature review. CASE REPORT: The authors describe two cases of orbital abscess caused by paranasal sinus infection. In case 1, the patient presented a decreased visual acuity associated with ophthalmoplegia of the right eye. In case 2, the patient presented a decreased visual acuity. Thus, administration of intravenous antibiotic combined with surgical drainage was performed. After surgical procedure, eye movements were normalized in case 1, and in both patients, the visual acuity returned to normal parameters. DISCUSSION: The authors recommend early surgical drainage with parenteral antibiotic administration and careful postoperative observations by monitoring the signs and symptoms of the orbital complaint.
Asunto(s)
Absceso/etiología , Celulitis Orbitaria/etiología , Periostitis/etiología , Absceso/diagnóstico , Absceso/cirugía , Adolescente , Antibacterianos/uso terapéutico , Brasil , Niño , Terapia Combinada , Femenino , Humanos , Imagen por Resonancia Magnética , Oftalmoplejía/etiología , Celulitis Orbitaria/diagnóstico , Celulitis Orbitaria/cirugía , Periostitis/diagnóstico , Periostitis/cirugía , Cuidados Posoperatorios , Sinusitis/complicaciones , Sinusitis/diagnóstico , Sinusitis/cirugía , Tomografía Computarizada por Rayos X , Agudeza VisualRESUMEN
INTRODUCTION: Orbital infections may result in permanent morbidity because of the severity of infection. Furthermore, delayed diagnosis or treatment of orbital infections can lead to intracranial complications and even death. The majority of orbital infections develop from paranasal sinus infections, cutaneous infections, and periorbital trauma. Dacryocystitis and odontogenic infection are also accounted as potential etiologies but are scarcely reported in scientific literature. METHODS: The patient revealed a history of having endodontic treatment on left maxillary second molar performed 2 weeks previously. Moreover, she exhibited signs of facial pain accompanied by sinusitis symptoms, fever, and nasal obstruction the week after this endodontic procedure. The patient presented proptosis, impairment of ocular motility to the right side, facial tenderness, palpebral erythema, and referred decreased visual acuity. Intraoral exam revealed root fragments of left maxillary first molar and an extensive carious lesion on left maxillary second molar. Computed tomography enabled the observation of frontal sinus, left-sided maxillary, opacity of sphenoidal and ethmoidal sinuses, and apical lesion of left maxillary first and second molars, all suggesting the presence of their apex in the maxillary sinus. In addition, images revealed ocular proptosis and presence of high-density areas suggestive of pus in the medial orbital wall region. RESULTS: The patient was submitted to surgical drainage under general anesthesia approximately 8 hours after the clinical evaluation. CONCLUSIONS: Early detection of orbital infection, proper diagnostic tests, and treatment may provide successful outcomes of this rarely occurring disease.
Asunto(s)
Celulitis Orbitaria/etiología , Fístula Oroantral , Absceso Periapical/complicaciones , Tratamiento del Conducto Radicular/efectos adversos , Femenino , Humanos , Trastornos de la Motilidad Ocular/etiología , Trastornos de la Motilidad Ocular/cirugía , Celulitis Orbitaria/diagnóstico por imagen , Celulitis Orbitaria/cirugía , Fístula Oroantral/complicaciones , Fístula Oroantral/etiología , Fístula Oroantral/cirugía , Absceso Periapical/cirugía , Radiografía , Extracción DentalRESUMEN
The authors report the case of na eighteen years old patient with a clinical picture of orbital abscess caused by ethmoid sinusitis. The decision for surgical intervention results from correlation between clinical findings and from the image diagnosis.
Relato de um caso de uma paciente de 18 anos com um quadro clinico de abscesso orbital causado por sinusite etmoidal. A decisão pela intervenção cirúrgica resultou da correlação entre achados clínicos e do diagnóstico dos exames de imagem.
Asunto(s)
Humanos , Femenino , Adolescente , Drenaje/métodos , Absceso/terapia , Endoscopía/métodos , Celulitis Orbitaria/terapia , Tomografía Computarizada por Rayos X , Sinusitis del Etmoides/complicaciones , Sinusitis del Etmoides/diagnóstico por imagen , Exoftalmia , Absceso/etiología , Absceso/diagnóstico por imagen , Celulitis Orbitaria/etiología , Celulitis Orbitaria/diagnóstico por imagenRESUMEN
PURPOSE: To describe the clinical and radiologic features of 4 cases of ossifying fibroma affecting the orbit and to review the literature on orbital involvement by the tumor. METHODS: Small case series. RESULTS: Four patients (3 children and 1 adult) with ossifying fibromas invading the orbit were examined. Two of the 3 children were examined for ossifying fibromas on the orbital roof. One had the psammomatoid form of the disease and the other the trabecular variant. Despite striking differences in the histologic pattern and in the radiologic appearance of the lesions, both children displayed a significant degree of orbital inflammation mimicking orbital cellulitis. The third child and the adult patient had the orbit involved by trabecular ossifying fibromas invading the orbital floor. The tumor of the adult clearly originated in the maxilla, filled the maxillary sinus, and eroded the orbital floor. The tumor of the third child occupied the maxillary, ethmoid, and sphenoid sinuses. In both cases, the clinical presentation was painless eye dystopia and proptosis. CONCLUSIONS: Regardless of the histologic pattern (trabecular or psammomatoid), ossifying fibromas can induce a substantial degree of orbital inflammation in children and must be included in the differential diagnosis of acute orbital inflammation during childhood.
Asunto(s)
Fibroma Osificante/complicaciones , Celulitis Orbitaria/etiología , Neoplasias Orbitales/complicaciones , Adolescente , Niño , Exoftalmia/etiología , Femenino , Fibroma Osificante/diagnóstico por imagen , Fibroma Osificante/patología , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Celulitis Orbitaria/diagnóstico por imagen , Celulitis Orbitaria/patología , Neoplasias Orbitales/diagnóstico por imagen , Neoplasias Orbitales/patología , RadiografíaRESUMEN
BACKGROUND: Orbital cellulitis after strabismus surgery is uncommon, may cause blindness and may lead to death. Very few cases have been described in detail due to the low incidence of this complication. METHODS: We report the first case of orbital cellulitis following Faden operation on the medial rectus muscle. We believe that the infection was due to asymptomatic ethmoid sinusitis. Our case is compared with other cases previously reported. RESULTS: A two-year-old boy was surgically treated for residual esotropia after two botulinum toxin A injections. Two days after surgery, signs of orbital cellulitis developed in his right orbit. CT-scan disclosed right ethmoid sinusitis that spread to the orbit after surgery. After intravenous antibiotic treatment, the infection resolved with full restoration of visual acuity and ocular motility. CONCLUSION: Despite adequate measures to prevent infection, orbital cellulitis may complicate strabismus surgery. Patients must be instructed to recognize early symptoms of this severe infection and call the surgeon immediately. Diagnosis may be confirmed by CT-scanning of the orbits. Prompt treatment with intravenous antibiotics usually leads to full recovery.