The majority of the cases occur in children and the focus of
the infection is predominantly in the ethmoid sinuses.
Infection spreads through the lamina papyracea into the
orbit by passing through bony dehiscences or through
thrombosed communicating vessels. Initially there may just
be a mild cellulitis with an inflamed upper eyelid, no
restriction of eye movement, and no proptosis. It may
be difficult to differentiate the diagnosis at this stage from
causes of pre-septal infection such as infections of the
lacrimal glands, abscesses of the upper lid, and
infections of the nasolacrimal duct.
Subsequently, a peri-orbital cellulitis may develop in the
post-septal part of the orbit. At this point the oedema of the
lid is worse, it is difficult to open the eye, and there is
proptosis with possible restriction of eye movement and
diplopia. If a subperiosteal abscess develops there is a signifi –
cant risk to the vision. (Colour vision tends to be lost before
black and white). Diagnosis is mainly clinical but imaging
studies help identify the presence of an abscess or cellulitis
and may help differentiate between pre- and septal infections
In rare cases an intraorbital abscess can be found.



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