Rhinogenic orbital complications are a large group of pathological conditions resulting from the spread of an infectious process from the nasal cavity and paranasal sinuses to the orbital region. Patients with rhinogenic orbital complications belong to the category of especially severe patients who require emergency hospitalization in specialized inpatient departments and an immediate complex of therapeutic measures. Rhinogenic orbital complications can threaten the patient with severe consequences up to the loss of an eye. Symptoms of orbital complications are already evident on physical examination and help in the timely diagnosis and treatment of such conditions.
General classification of rhinogenic orbital complications
Rhinogenic orbital complications include both simple edema and purulent inflammation and even thrombosis. The prevalence and nature of the lesion depends primarily on the primary focus of infection and the state of the patient's immune system. There are such rhinogenic orbital complications:
- reactive edema of the eyelids and orbital tissue;
- purulent or non-purulent orbital osteoperiostitis;
- eyelid abscess;
- subperiosteal abscess;
- phlegmon of the orbit;
- retrobulbar abscess;
- thrombosis of the veins of the eye tissue.
Clinical manifestations of rhinogenic orbital complications
Clinical manifestations of rhinogenic orbital complications are divided into general and local symptoms. Common symptoms include an increase in body temperature to febrile values, headache, weakness, nausea, and sometimes vomiting. Local manifestations are individual for each type of rhinogenic orbital complications:
- reactive edema of the eyelid and orbital tissue is manifested by swelling of the affected eyelid, exophthalmos and eye tenderness on palpation;
- with a subperiosteal abscess, the eyeball shifts upward, exophthalmos, eyelid edema, conjunctival chemosis may occur;
- eyelid abscess has a characteristic symptom: the eyeball is closed by a swollen and immobile eyelid, which is tense and very painful on palpation;
- Retrobulbar abscess and orbital phlegmon are manifested by painful exophthalmos, ophthalmoplegia, diplopia and decreased vision;
- with thrombosis of the veins of the fiber of the eye, swelling and infiltration of the eyelids are detected at first in one eye, then the second is also affected. Dense vascular bands of a bluish color are visualized around the eye.
Methods for diagnosing rhinogenic orbital complications
The diagnostic process of rhinogenic orbital complications is not difficult, since the characteristic symptoms of pathological conditions are already determined during an objective examination with the naked eye. If necessary, to clarify the prevalence of the pathological process, X-ray data, computed tomography of the paranasal sinuses, and rhinoscopy are used. In some cases, it is necessary to conduct a diagnostic puncture of the nasal sinuses, an ophthalmological examination with the determination of visual acuity and fields. The differential diagnosis of rhinogenic orbital complications is carried out, first of all, with erysipelas, hematoma and emphysema of the eyelid, neoplasms of the orbit.
Methods of treatment of rhinogenic orbital complications
Treatment of rhinogenic orbital complications depends on the nature of the orbital lesion and implies emergency surgical intervention. The surgical operation is aimed at eliminating the primary purulent focus in the sinuses. For this purpose, a radical operation is performed on the affected paranasal sinus, all pathologically altered tissues are completely removed and a wide fistula with the nasal cavity is formed. With abscesses of the fiber of the orbit, subperiosteal abscesses and phlegmon & nbsp; the focus of infection is opened and drained without fail. Such operations can be combined with decompression of the orbital tissue by endonasal endoscopic methods. Parallel antibacterial and anti-inflammatory therapy is also recommended.
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