Orbital Infections

Orbital infections account for the majority of primary intraorbital disease processes. Sinusitis is the most common aetiology. Systemic conditions which predispose to orbital infection include diabetes, septicaemia, malignancy, and immunosuppression. Clinical signs and symptoms include superficial inflammatory changes, as well as proptosis, limitation of extraocular motility, and visual loss. Causative agents are most commonly bacteria, with fungi, viruses, and parasites seen less frequently. Imaging is performed by CT and/or MRI which are complementary in certain cases. Differential diagnosis of imaging abnormalities includes inflammatory and granulomatous diseases, as well as neoplasm. Morbidity and mortality associated with the condition have declined with advances in diagnostic and therapeutic options; however, orbital infection can still lead to serious sight- and life-threatening complications in the modern antibiotic era. Therefore, prompt diagnosis and treatment remain crucial. Antibiotic coverage and surgical intervention when needed have benefitted patients and changed the disease prognosis. Indications for surgical drainage should be based on clinical and radiological findings. Loss of vision, an unresponsive pupil or a densely packed orbit are indications for immediate surgical drainage. We review the characteristics of orbital infections, predisposing factors, current evaluation strategies, and management of the disease.