PENYAKIT ORBITA

FKK UMJ SRI FULINA

Orbital Diseases
Preseptal cellulitis Orbital cellulitis

ANATOMI ORBITA
Orbita : btk spt buah Pir dengan n.optikus sebagai tangkainya. Volume orbita : 30 cc Bolamata hanya 1/5 bgn ruangannya. Lemak dan otot menempati bagian terbesar. Batas anterior rongga orbita adalah septum orbita yg berfungsi sebagai pemisah antara palpebra dan orbita.

Orbita berhubungan dengan : - Bgn atas : sinus frontalis - Bgn bawah : sinus maksilaris - Bgn medial : sinus etmoidal dan sinus spenoidal. - Bgn dasar : tipis mudah rusak oleh trauma langsung terhadap bolamata frakturblow out dgn herniasi isi orbita kedalam antrum maksilaris

Vaskularisasi : - A.Oftalmika cabang pertama dari a,karotis interna (intra kranial ) - Cabang intra orbita - a.retina sentralis yang memasuki n.optikus sekitar 8-15 mm dibelakang bolamata.
Cabang a.oftalmika-a.lakrimalis memperdarahi gld.lakrimalis dan palpebra superior. Cabang-cabang muskularis ke berbagai otot orbita : - a.siliaris post longus/brevis - a.palpebralis medialis untuk palpebra. - a.supraorbitalis - a.supratroklearis

A.siliaris posterior brevis memperdarahi koroid dan bagian-bagian n.optikus. Kedua a.siliaris post longa memperdarahi korpus siliaris dan saling beranastomosis satu sama lain dan dgn a.siliaris ant membentuk sirkulus arterialis mayor iris. Cabang-cabang muskular a.siliaris ant menuju muskuli rekti dan memasok darah ke sklera,episklera,limbus dan konyungtiva serta turut membentuk sirkulus arterialis mayor iris.

Aliran vena orbita tu mel v.oftalmika sup dan inf juga menampung darah dari v.vorteks,v.siliaris ant dan v.retina sentralis. V.Oftalmika berhubungan dgn sinus kavernosus mel fissura orbitalis sup dan dgn pleksus venous pterigoideus mel fissura orbitalis inf. V.Oftalmika sup mula-mula di bentuk dari v.Supraorbitalis dan v.supratroklearis dan dari satu cabang v.angularis yg semuanya mengalirkan darah dari kulit di daerah periorbital.

Vena ini membentuk hubungan langsung antara kulit wajah dgn sinus kavernosus , sehingga dapat menimbulkan trombosis sinus kavernosus yg potensial fatal akibat infeksi superfisial di kulit periorbital.

Differentiation between preseptal and orbital cellulitis is important because treatment, prognosis, and complications are different

Preseptal Cellulitis
Infection of the eyelids and soft tissue structures anterior to the orbital septum May be due to skin infection, trauma, upper respiratory illness or sinus infection

Preseptal Cellulitis - Symptoms

Mild to very severe eyelid edema Eyelid erythema Normal ocular motility Normal pupil exam Mild systemic signs (fever, preauricular and submandibular adenopathy)

Preseptal Cellulitis - Evaluation

Swab drainage if present for gram stain and culture Blood cultures in more severe cases CT scan of orbit to assess the paranasal sinuses, posterior extention into the orbit, and presence of subperiosteal or orbital abcesses

Preseptal Cellulitis - treatment

Systemic antibiotics The younger the patient and the more severe the disease the more likely to initiate inpatient treatment (IV antibiotics)

Preseptal selulitis

Orbital Cellulits
Infectious process posterior to the orbital septum that affects orbital contents Medical emergency !!!! Requires combined efforts of pediatrician, ophthalmologist and often otolaryngologist for management

Orbital Cellulitis - Causes

Bacterial infection of the adjacent paranasal sinuses, particularly the ethmoids Infants may develop secondary to dacryocysitis (infection of the nasolacrimal system)

Orbital Cellulitis Signs and Symptoms

Redness and swelling of lids Impaired motility often with pain on eye movement Proptosis Decreased vision Afferent pupillary defect Optic disc edema

Orbital Cellulitis: Note the marked lid swelling and erythema

Orbital Cellulitis: Note the periorbital edema and erythema and the chemosis (conjunctival swelling)
Picture from Section 6 of the Basic and Clinical Science Course published by the Foundation of the American Academy of Ophthalmology

Orbital selulitis

Orbital sellulitis associated with orbital absces

Orbital Cellulitis Management

Hospitilization Ophthalmology consult (urgent) Blood culture Orbital CT scan IV antibiotics

Orbital Cellulitis Complications

Optic nerve damage (permanent visual loss) Meningitis in 1.9% of cases as infection may spread through the valveless orbital veins Subperiosteal abcess Cavernous sinus thrombosis

Subperiosteal abcess of the left orbit. Note the dome shaped elevation of the periosteum along the left medial orbital wall.
Picture from Section 6 of the Basic and Clinical Science Course published by the Foundation of the American Academy of Ophthalmology

R
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Cavernosis sinus thrombosis

CTS is obstruction cavernosis sinus by thrombus. The obstruction cause venous stagnation sign in eye.

Main cause : Infection from other place such as ; face,mid ear,head,mouth,paranasalis sinus or orbita. Pathogenesis : Thrombus-material consists of blood component in vessels or heart. The process ---thrombuscavernosis sinus---infection.

Thrombus can occur by 4 factors:

1.

2.

3.

4.

Infection by microorganisms especially streptococcus. Alteration of endothelial layer of the blood vessels. Irritation or toxin---endothelial rough adhesion of thrombus. Alteration of blood viscocityfibrin Alteration of blood circulation.

Clinical featurs :
Systemic : - Fever - Head ache - Nauseous / vomiting - Consiousness - Dead

Ocular
Supraorbital pain Lacrimation Severe illness

Photofobia Decreased of vision Exopthalmos Palpebral edema Periorbital edema Pupil reflex Papil edema Extraocular muscle paresis Hazy cornea One eye . 24-46 hours the fellow eye

Diagnosis : - Anamnesis---infection from the other place. - Systemic evaluation - Funduscopy papil edema - Laboratorium leucositosis - Angiography --- filling defect - CT Scan

Management : - Total bed rest - IVFD dextrose 5% - IV Antibiotik - Eye ointment

Differential diagnosis:
1.

2.

3.

Orbital cellulitis : - unilateral - no papil edema - normal pupil reflex A-V Aneurisma : - exophthalmos with noise Pseudotumor orbita : - limitation eye movement - exophthalmos - palpebra edema without inflam

Prognosis :
Depend of the adequad of management and therapy. The patient could died --complication