Tomographic findings of acute infections of the orbit:
               literature review

The acute and nontraumatic diseases that involve the orbit are often little known by most physicians. These conditions are due to several factors, such as immune disorders, congenital, infections, vascular, among others disorders. The infectious causes correspond to more than 50% of all cases and require rapid diagnosis and management in order to minimize sequels. Computed tomography (CT) is the first line imaging method on these cases, generally being available in emergency centers and capable to provide an accurate, quick and effective diagnostic information. This review article aims to describe the main tomographic findings in acute orbit infections, correlating them with the literature data.

X-ray, computed tomography; Acute infection; Orbit/pathology

Authorship

Ana Célia Baptista Koifman

Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro/RJ, Brazil.Federal University of the State of Rio de JaneiroBrazilRio de Janeiro, RJ, BrazilFederal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro/RJ, Brazil.

Bernardo Gribel Carneiro

Luiz Eugênio Bustamante Prota Filho

Nadja Emídio Corrêa de Araújo

Volta Redonda University Centre (UniFOA), Volta Redonda/RJ, Brazil.Volta Redonda University CentreBrazilVolta Redonda, RJ, BrazilVolta Redonda University Centre (UniFOA), Volta Redonda/RJ, Brazil.

Carolina Maria de Azevedo

Vitor Barbosa Cerqueira

Estácio de Sá University (UNESA), Rio de Janeiro/RJ, Brazil.Estácio de Sá UniversityBrazilRio de Janeiro, RJ, BrazilEstácio de Sá University (UNESA), Rio de Janeiro/RJ, Brazil.

The authors declare no conflict of interest.

SCIMAGO INSTITUTIONS RANKINGS

Volta Redonda University Centre (UniFOA), Volta Redonda/RJ, Brazil.Volta Redonda University CentreBrazilVolta Redonda, RJ, BrazilVolta Redonda University Centre (UniFOA), Volta Redonda/RJ, Brazil.

Estácio de Sá University (UNESA), Rio de Janeiro/RJ, Brazil.Estácio de Sá UniversityBrazilRio de Janeiro, RJ, BrazilEstácio de Sá University (UNESA), Rio de Janeiro/RJ, Brazil.

Figures

Figures (8)

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Figure 1
Post-septal cellulitis: Patient with acute sinusitis and right proptosis starting 3 days earlier. Axial CT without contrast. Bilateral opacification of the ethmoid sinuses. Increased density in the intra- and extraconal fat of the right orbit, especially in the medial quadrant (A) (arrow), with mild proptosis (B). Note that the left orbital fat has normal density (A and B) (arrowheads).

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Figure 2
Subperiosteal abscess: adult patient with a history of untreated acute sinusitis with progressive proptosis of the right eye starting four days earlier. Axial CT (A) reformatted in the coronal plane (B) after contrast injection. Right maxillo-ethmoidal opacification and subperiosteal collection in the medial quadrant of the adjacent orbit (arrows) associated with a thickened medial rectus muscle (arrowhead).

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Figure 3
Bilateral subperiosteal abscess: 12-year-old male patient with sickle cell anaemia reporting fever and right proptosis starting 2 days earlier, with leukocytosis. Axial CT before (A) and after (B) contrast injection. Subperiosteal collection in the lateral quadrant of the right orbit with peripheral enhancement by the contrast medium (large arrow), causing proptosis and medial displacement of the eyeball. Note a symmetrical, smaller collection on the left side (small arrow).

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Figure 4
Acute dacryocystitis: 6-year-old patient with a history of congenital stenosis of the left nasolacrimal duct complaining of pain, bulging and redness in the inner corner of the left orbit, starting 2 days earlier. Axial CT after contrast injection (A and B). Collection in the topography of the left lacrimal sac (large arrow) and thickened pre-septal soft tissues (small arrow). Note the significant peripheral enhancement of the collection by the contrast medium (arrowhead).

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Figure 5
Infected dermoid cyst: 26-year-old male patient with longterm proptosis and lateral-inferior displacement of the left eyeball, complaining of bulging and intense pain in the inner corner of the ipsilateral orbit starting one day earlier. Axial CT before (A) and after (B) contrast injection. Heterogeneous cystic oval lesion with a partially fatty content (-115 HU), forming a liquid level in the upper medial quadrant of the left orbit. Note the peripheral enhancement by the contrast medium (small arrow), bone remodeling of the adjacent lamina papyracea (large arrow), and significantly increased density in the pre-lesional fat (arrowhead). Also note the lateralinferior displacement of the left eyeball with proptosis.

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Figure 6
Ophthalmomyiasis: homeless elderly patient with a history of enucleation of the right eye of unknown cause, presenting with facial myiasis and pain in the right orbital region starting six days earlier. Axial CT after contrast injection. Irregular and amorphous thickening of pre- and intra-orbital soft tissues due to larval invasion.

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Figure 7
Gradenigo's syndrome: 7-year-old female patient with a history of recurrent otomastoiditis presents with right retro-ocular pain, ipsilateral impairment of visual acuity, and diplopia starting one day earlier. Axial (A) and coronal (B) CT in bone window. Complete opacification of the right tympanic cavity and mastoid air cells (arrowheads). The right petrous apex is also opacified, with coalescence and associated erosion (large arrows). Note the pneumatisation of the petrous apex and normal mastoid aeration on the left side (small arrows).

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Figure 8
Infected mucocele: 17-year-old female patient with right eye pain, ptosis, and frontal bulging starting 4 days earlier. CT after contrast injection in the axial plane (A) reformatted in the coronal plane (B). A. Collection originating from the right frontal sinus (arrow) with significant thickening of pre-orbital soft tissues (arrowheads). The eyeball is not identified at this level due to its inferior displacement. B. Collection in the topography of the right frontal sinus (arrow) with wall enhancement after contrast injection, associated with erosion of the upper and lower bony walls of the sinus cavity. Part of the lesion projects into the upper medial quadrant of the ipsilateral orbit and the anterior cranial fossa. Note the infero-lateral displacement of the eyeball on this side.

Figure 1 Post-septal cellulitis: Patient with acute sinusitis and right proptosis starting 3 days earlier. Axial CT without contrast. Bilateral opacification of the ethmoid sinuses. Increased density in the intra- and extraconal fat of the right orbit, especially in the medial quadrant (A) (arrow), with mild proptosis (B). Note that the left orbital fat has normal density (A and B) (arrowheads).

Figure 2 Subperiosteal abscess: adult patient with a history of untreated acute sinusitis with progressive proptosis of the right eye starting four days earlier. Axial CT (A) reformatted in the coronal plane (B) after contrast injection. Right maxillo-ethmoidal opacification and subperiosteal collection in the medial quadrant of the adjacent orbit (arrows) associated with a thickened medial rectus muscle (arrowhead).

Figure 3 Bilateral subperiosteal abscess: 12-year-old male patient with sickle cell anaemia reporting fever and right proptosis starting 2 days earlier, with leukocytosis. Axial CT before (A) and after (B) contrast injection. Subperiosteal collection in the lateral quadrant of the right orbit with peripheral enhancement by the contrast medium (large arrow), causing proptosis and medial displacement of the eyeball. Note a symmetrical, smaller collection on the left side (small arrow).

Figure 4 Acute dacryocystitis: 6-year-old patient with a history of congenital stenosis of the left nasolacrimal duct complaining of pain, bulging and redness in the inner corner of the left orbit, starting 2 days earlier. Axial CT after contrast injection (A and B). Collection in the topography of the left lacrimal sac (large arrow) and thickened pre-septal soft tissues (small arrow). Note the significant peripheral enhancement of the collection by the contrast medium (arrowhead).

Figure 5 Infected dermoid cyst: 26-year-old male patient with longterm proptosis and lateral-inferior displacement of the left eyeball, complaining of bulging and intense pain in the inner corner of the ipsilateral orbit starting one day earlier. Axial CT before (A) and after (B) contrast injection. Heterogeneous cystic oval lesion with a partially fatty content (-115 HU), forming a liquid level in the upper medial quadrant of the left orbit. Note the peripheral enhancement by the contrast medium (small arrow), bone remodeling of the adjacent lamina papyracea (large arrow), and significantly increased density in the pre-lesional fat (arrowhead). Also note the lateralinferior displacement of the left eyeball with proptosis.

Figure 6 Ophthalmomyiasis: homeless elderly patient with a history of enucleation of the right eye of unknown cause, presenting with facial myiasis and pain in the right orbital region starting six days earlier. Axial CT after contrast injection. Irregular and amorphous thickening of pre- and intra-orbital soft tissues due to larval invasion.

Figure 7 Gradenigo's syndrome: 7-year-old female patient with a history of recurrent otomastoiditis presents with right retro-ocular pain, ipsilateral impairment of visual acuity, and diplopia starting one day earlier. Axial (A) and coronal (B) CT in bone window. Complete opacification of the right tympanic cavity and mastoid air cells (arrowheads). The right petrous apex is also opacified, with coalescence and associated erosion (large arrows). Note the pneumatisation of the petrous apex and normal mastoid aeration on the left side (small arrows).

Figure 8 Infected mucocele: 17-year-old female patient with right eye pain, ptosis, and frontal bulging starting 4 days earlier. CT after contrast injection in the axial plane (A) reformatted in the coronal plane (B). A. Collection originating from the right frontal sinus (arrow) with significant thickening of pre-orbital soft tissues (arrowheads). The eyeball is not identified at this level due to its inferior displacement. B. Collection in the topography of the right frontal sinus (arrow) with wall enhancement after contrast injection, associated with erosion of the upper and lower bony walls of the sinus cavity. Part of the lesion projects into the upper medial quadrant of the ipsilateral orbit and the anterior cranial fossa. Note the infero-lateral displacement of the eyeball on this side.

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Tomographic findings of acute infections of the orbit: literature review

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[1] The authors declare no conflict of interest.