Moloney et al described different stages of acute orbital inflammatory complications associated with acute sinusitis. The authors are from Leicester in England.
Differences from the classification of Chandler et al (above):
(1) Chandler's inflammatory edema is replaced by preseptal cellulitis. The former was painless edema of the eyelid with or without edema of the orbital contents, while the latter is a true cellulitis with associated with pain on palpation.
(2) Periorbital is used to describe preseptal tissues.
(3) The order of orbital cellulitis and subperiosteal abscess are reversed.
Description of the orbital septum : This is a thin connective tissue membrane that runs from the orbital margins into the eyelids. Laterally it is attached at the lateral orbital tubercle (as the lateral palpebral ligament). Medially it attaches at the posterior and anterior lacrimal crest (the latter as the medial palpebral ligament).
|
Stage |
Descriptor |
Features |
|
I |
preseptal cellulitis |
inflammation anterior to the orbital septum\ |
|
II |
subperiosteal abscess |
abscess between the orbital bone and the periosteum lining it |
|
III |
orbital cellulitis |
diffuse cellulitis within the retrobulbar soft tissue, external to the periosteum |
|
IV |
orbital abscess |
an abscess within the retrobulbar soft tissue, external to the periosteum |
|
V |
cavernous sinus thrombosis (thrombophlebitis) |
inflammation within the cavernous sinus that is initially unilateral but then often becomes bilateral |
where:
• A modification would be to use Stage IA to correspond to Chandler's inflammatory edema and Stage IB to describe a true cellulitis.
• The stages usually do not progress from one to the next, although this may occur. Each can occur independently without preceding stages occurring.
|
Stage |
Descriptor |
Features |
|
I |
preseptal cellulitis |
may show edema of one or both eyelids, erythema, warmth, tenderness, chemosis, and/or closure of the palpebral fissure |
|
II |
subperiosteal abscess |
preseptal cellulitis, chemosis, proptosis, limitation of ocular mobility, tenderness between the bony orbital margin and the globe, occasionally decreased visual acuity |
|
III |
orbital cellulitis |
preseptal cellulitis, chemosis, proptosis, pain in the eye, ocular tenderness, limited eye mobility, ophthalmoplegia, fixation of the pupil, decreased visual acuity, increased intraocular pressure |
|
IV |
orbital abscess |
marked preseptal cellulitis. chemosis, proptosis, immobility of the globe, decreased visual acuity, afferrent pupillary defect, edema of the optic disc and congestion of the retinal veins |
|
V |
cavernous sinus thrombosis (thrombophlebitis) |
proptosis, cranial nerve palsies, meningismus or meningitis, dilatation of the episcleral veins |
Specialty: Ophthalmology, Infectious Diseases, Immunology/Rheumatology
