Journal Article

Orbital complications of paranasal sinusitis in Taiwan, 1988 through 2015: Acute ophthalmological manifestations, diagnosis, and management

Chang, Yi-Sheng, Lai, Chun-Chieh, Wang, Chien-Kuo, Cheng, Hon-Chun, Tseng, Sung-Huei, Chen, Hsiao-Yen, Ou, Chun-Yen, Chen, Po-Lin, Hung, Jia-Horung, Chang, Chia-Ming

2017

Overview

Paranasal sinusitis is widespread and can lead to orbital complications, blindness, and death. However, the correlation between ophthalmological findings and disease staging remains unclear. This study aimed to investigate the staging, acute ophthalmological manifestations, diagnosis, management, and outcomes of orbital complications of paranasal sinusitis during a 27-year period. We retrospectively reviewed the medical records of all patients with orbital complications of paranasal sinusitis hospitalized at the National Cheng Kung University Hospital, a medical center in Taiwan during 1988-2015. Sex, age, symptoms, history, ophthalmological findings, laboratory and imaging findings, treatments, and outcomes were analyzed by staging. Eighty-three patients aged 9 days to 80 years had stage I (preseptal cellulitis, n = 39 patients), II (postseptal orbital cellulitis, n = 8), III (subperiosteal abscess, n = 16), IV (orbital abscess, n = 8), or V (intracranial involvement, n = 12) complications. Peak incidences occurred in patients aged 0-19 and 60-69 years. Chronic sinusitis and diabetes mellitus were common preexisting diseases. Extraocular movement limitation and proptosis predicted postseptal (stage II or more) involvement. The likelihood of elevated intraocular pressure increased with stage. Reduced visual acuity and presence of relative afferent pupillary defect indicated consideration of magnetic resonance imaging to investigate possible intracranial extension. Ipsilateral maxillary (81.7%) and ethmoidal (75.6%) sinuses were the most common sources of infection, and the most frequently implicated pathogens were coagulase-negative Staphylococcus spp. (25.3%) and Staphylococcus aureus (20.5%). All patients received intravenous antimicrobial therapy (multi-drug therapy in 88.0%), and 55.4% underwent surgery, most commonly endoscopic sinus surgery. One (1.2%) diabetic man with stage V complications died of fungal sinusitis with intracranial invasion. Five (6.0%) patients, all stage V, lost vision despite intensive treatment. The average length of hospital stay was 13.8 days (range 2-72 days), and significantly longer stays were associated with stages II-V as compared to stage I. Orbital infection originating from paranasal sinusitis can cause vision loss and death due to intracranial extension. Acute ophthalmological findings predict staging and prognosis. Cooperative consultation between ophthalmologists, otorhinolaryngologists, and neurologists is essential. Urgent diagnostic studies and aggressive antimicrobial therapy are indicated, and surgery should be considered.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acuity / Acute Disease / Adolescent / Adult / Aged / Aged, 80 and over / Antiinfectives and antibacterials / Biology and Life Sciences / Blindness / Care and treatment / Cellulitis / Child / Child, Preschool / Clinical medicine / Coagulase / Complications / Complications and side effects / Consultation / Diabetes / Diabetes mellitus / Diagnosis / Diagnostic systems / Edema / Endoscopes / Family medical history / Female / Fungi / Health care facilities / History, 20th Century / History, 21st Century / Hospitals / Humans / Infant / Infant, Newborn / Infections / Infectious diseases / Inflammation / Internal medicine / Intraocular pressure / Intravenous administration / Laboratories / Lightning / Magnetic resonance / Magnetic Resonance Imaging / Male / Maxilla / Medical diagnosis / Medical imaging / Medical records / Medicine / Medicine and Health Sciences / Middle Aged / Nose / Ophthalmology / Orbital cellulitis / Orbital Diseases - diagnostic imaging / Orbital Diseases - drug therapy / Orbital Diseases - etiology / Otolaryngology / Paranasal Sinuses - diagnostic imaging / Paranasal Sinuses - pathology / Pathogens / Patients / Pediatrics / Research and Analysis Methods / Risk factors / Sensory neurons / Sinus / Sinuses / Sinusitis / Sinusitis - complications / Sinusitis - drug therapy / Social Sciences / Staphylococcal infections / Storms / Surgery / Taiwan / Therapy / Thrombosis / Tomography / Tomography, X-Ray Computed / Vision / Visual acuity / Visual perception / Young Adult