Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Orbital Selülitli Hastaların Demografik Özellikleri ve Klinik Yaklaşım
Demographic Characteristics of Orbital Cellulite Cases and Clinical Approach
Erdinç BOZKURTa, Osman ÖNDAŞb
aGöz Hastalıkları AD, Kafkas Üniversitesi Tıp Fakültesi, Kars, TÜRKİYE
bGöz Hastalıkları AD, Atatürk Üniversitesi Tıp Fakültesi, Erzurum, TÜRKİYE
Turkiye Klinikleri J Ophthalmol. 2019;28(3):141-7
doi: 10.5336/ophthal.2018-63346
Article Language: TR
Full Text
ÖZET
 Amaç: Orbital selülit hastalarında etiyoloji, tanı, tedavi yöntemleri ve prognozun değerlendirilmesidir. Gereç ve Yöntemler: Atatürk Üniversitesi Tıp Fakültesi Göz Hastalıkları Kliniğine Eylül 2013- Haziran 2017 tarihleri arasında orbital selülit tanısıyla başvuran hastaların dosyaları retrospektif olarak incelendi. Yaş, cinsiyet, muayene bulguları, etiyoloji, tedavi yöntemleri ve prognoz değerlendirildi. İstatistiksel analizlerde Wilcoxon testi kullanıldı, p<0,05 olması anlamlı olarak kabul edildi. Bulgular: Orbital selülit nedeni ile tedavi gören; 12 (%57,2)'si erkek, 9 (%42,8)'u kadın 21 hasta çalışmaya dâhil edildi. Hastaların tümünde başvuru anında kapaklarda kızarıklık, ödem ve oküler ağrı mevcut idi. On altı (%76) hastada bakış kısıtlılığı, 11 (%52,3)'inde kemozis, 10 (%47,6)'unda propitozis, 9 (%42,8)'unda diplopi, 7 (%33,3)'sinde rölatif afferent pupil defekti izlendi. Görüntüleme tetkiklerinde sinüzit bulgusu olan 18 hastanın 10 (%55,5)'unda etmoidal, 1 (%5,5)'inde maksiller, 5 (%27,7)'inde etmoidal ve maksiller, 1 (%5,5)'inde etmoidal ve sfenoidal, 1 (%5,5)'inde etmoidal, maksiller ve frontal sinüzit mevcut idi. Kulak burun boğaz ve enfeksiyon hastalıkları kliniklerine konsülte edilen hastaların sistemik antibiyotik tedavisinde geniş spektrumlu, kombine ilaç tedavisi tercih edildi. Radyolojik görüntülemede apse oluşumu izlenen 8 (%38) hastanın 4'üne endoskopik sinüs cerrahisi ve apse drenajı, kronik dakriyosistite sekonder apse oluşumu izlenen iki hastaya medikal tedavi sonrası dakriyosistorinostomi cerrahisi uygulandı. İki hastada ise spontan drenaj gerçekleşti. Tedavi öncesi en iyi düzeltilmiş görme keskinliği ortalama 0,67±0,43 (logMAR), tedavi sonrası ise 0,02±0,17 idi. Tüm hastalar takipleri sırasında, görme kaybı ve nörolojik komplikasyon gelişmeden iyileşti. Sonuç: Orbital selülit, oluşabilecek ciddi komplikasyonlar nedeni ile oftalmolojinin acillerindendir. Tedavi; göz hastalıkları, kulak burun boğaz ve enfeksiyon hastalıkları kliniklerinin ortak görüşü ile planlanmalı, hastalar multidisipliner olarak takip edilmeli ve orbital apse mevcut ise cerrahi uygulanmalıdır.

Anahtar Kelimeler: Apse; orbital selülit; prognoz; sinüzit
ABSTRACT
 Objective: To evaluate the etiology, diagnosis, treatment methods and prognosis of orbital cellulitis cases. Material and Methods: Patients with orbital cellulitis who had been treated and followed at Atatürk Universty Department of Ophtalmology between September 2013-June 2017 were included in the study. Age, sex, examination findings, etiology, treatment methods and prognosis were evaluated. Wilcoxon test was used for statistical analysis, p<0.05 was considered significant. Results: Twelve (57.2%) male and 9 (42.8%) female were included in the study. All patients had redness, oedema in the eyelids and had ocular pain at the time of presentation. There were 16 (76%) patients with restricted eye movement, 11 (52.3%) with chemosis, 10 (47.6%) with proptosis, 9 (42.8%) with diplopia and 7 (33.3%) with relative afferent pupillary defect. Etmoidal sinusitis was found in 10 (55.5%) patients, maxillary in 1 (5.5%), etmoidal and maxillary in 5 (27.7%), etmoidal and sphenoidal in 1 (5.5%), ethmoidal, maxillary and frontal in 1 (5.5%). A broad spectrum, combined drug therapy was preferred in the treatment of systemic antibiotics for patients who were consulted to the otolaryngology and infectious diseases clinics. In 8 (38%) patients with abscess formation on radiological imaging; endoscopic sinus surgery and abscess drainage were performed in 4, dacryocystorhinostomy surgery was performed after medical treatment in two patients. Spontaneous drainage occurred in two patients. The mean best corrected visual acuity before treatment was 0.67±0.43 (logMAR) and 0.02±0.17 after treatment. All patients recovered without visual loss and neurological complications. Conclusion: Orbital cellulitis is one of the emergencies of ophthalmology due to serious complications. The treatment should be planned with the common opinion of the clinics of ophthalmology, otolaryngology and infectious diseases, the patients should be followed up multidisciplinary. In case of orbital abscess surgery should be performed.

Keywords: Abscess; orbital cellulitis; prognosis; sinusitis
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