Purpose

To present a case of orbital cellulitis with a suspected odontogenic origin, highlighting the dental area as a cause of direct or indirect bacterial spread.

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Methods

Case Report

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Results

A 72yrs old male with DM 2 and COPD, paraplegic due to spondilodiscitis of septic origin four years prior, presented with rapidly progressive left-sided deterioration of vision, diplopia, periorbital edema and severe pain over two days. On presentation, the BCVA on LE was 0,6 Snellen decimal, severe chemosis, ptosis, restricted ocular motility, elevated intraocular pressure and choroidal detachment and multiple peripheral Roth spots on both eyes. CT of the orbit showed a hypodense intraconal lesion under the superior rectus without typical signs of orbital cellulitis.  Due to clinical signs of orbital cellulitis with orbital compartment syndrome emergency lateral canthotomy and cantholysis were performed and systemic antibiotic therapy was administered. Haematological origin was suspected due to bilateral Roth spots; however, haemocultures were negative, the chest X-ray was normal and the heart US did not show signs of endocarditis. Poor dental health was noted and on CT scan review periapical granulomas on the upper left side were described. Clinical picture worsened with proptosis and chemosis and an increase of inflammatory markers. Follow-up CT showed inflamed orbital fat and increased size of the hypodense lesion suggestive of an intraconal absces. Transconjunctival orbitotomy was performed and US assisted abscess localisation and drainage after which the clinical picture dramatically improved. Stomatological exam identified a periapical granuloma at tooth 27 with chronic apical periodontitis as a possible infectious source. Immediate extraction of tooth 27 was performed. Abscess cultures grew Campylobacter rectus, linked to chronic periodontitis.

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Conclusion

This case highlights the dental area as a possible source of bacterial spread to the orbit. Patients with orbital cellulitis of unknown origin should undergo dental examination with periapical assessment to identify and eliminate odontogenic sources.

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Additional Authors

First name	Last name	Base Hospital / Institution
Jure	Valentinčič	Eye Hospital, University Medical Centre Ljubljana
Ana	Sreič	Eye Hospital, University Medical Centre Ljubljana
Alenka	Lavrič Groznik	Eye Hospital, University Medical Centre Ljubljana,Medical Faculty, University of Ljubljana
Gregor	Hawlina	Eye Hospital, University Medical Centre Ljubljana, Medical Faculty, University of Ljubljana
Ana	Fakin	Eye Hospital, University Medical Centre Ljubljana, Medical Faculty, University of Ljubljana

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