Audit of the multidisciplinary management of orbital infection secondary to sinusitis

Acute infection of the orbit may have several aetiologies such as conjunctivitis, trauma and stye, and it may also be idiopathic. However, the most common cause is acute sinusitis spreading directly from the paranasal sinuses which are intimately related to the orbit. The maxillary and ethmoidal sinus infections are the most common causes of orbital involvement (Mill & Kartush 1985). Only the thin translucent bone of the lamina papyracea separates the ethmoidal air cells and the orbit. The infection may enter the orbit either by direct extension, by local thrombophlebitis or by infected thromboemboli along valveless venous connections (Chandler et al . 1970). Neurovascular foramina, congenital or acquired bony dehiscences and valveless venous channels provide potential routes for bacteria to spread from the sinus through the lamina papyracea to the periosteum of the orbit (Harris 1983). A classification of orbital infection secondary to sinusitis was advanced by Chandler in 1970 (Chandler et al . 1970). It is based on local pathological changes and does not include intracranial complications but does indicate worsening morbidity, long-term complications and even death. In the preantibiotic era, orbital cellulitis resulted in blindness in 20% of patients, 13% had grave impairment of vision and 17% died of meningitis (Gamble 1933; Duke Elder & MacFaul 1974). Despite advances in imaging and antibiotics, there is a significant 10% incidence of visual loss (Patt & Manning 1991). We report here an audit designed to improve current practice and instigate a multidisciplinary approach to the management of orbital infections secondary to sinusitis and improve the quality of care offered to these patients.