Ophthalmic orbititis Augenhöhlenentzu

Definition – What is orbital inflammation?

An orbital inflammation is an inflammation of the orbita (eye socket). The orbit forms a bony pit in the skull, in which the eyeball, including the eye muscles, connective tissue, blood vessels and nerves are located. The orbit is closely related to the frontal sinus, the cranial cavity and the maxillary sinus, which is why inflammations from this area can easily spread.

Inflammation of the orbit is a serious clinical picture that can lead to serious complications. Due to the proximity to the cranial cavity and the brain, the inflammation can lead to a life-threatening blockage of the cerebral arteries or a brain abscess. Inflammation of the orbit causes pain, which is particularly noticeable when moving the eyes.

Due to movement disorders of the eye muscles, the diseased persons have problems seeing: typically, double images occur because the eyeballs can no longer be aligned correctly. As a result of the inflammation, the tissue inside the eye socket swells. The other symptoms of an eye socket inflammation can vary greatly depending on the cause.

Other symptoms include swelling of the upper and lower eyelids, watery eyes, problems with eyelid closure and redness. Headaches or may be indications of an eye orbit inflammation. The outer eye muscles and numerous nerves and blood vessels are located in the eye socket.

In the event of an inflammation, the tissue inside the eye socket swells considerably, which can cause severe pain. Especially the movement of the eyes is extremely painful and in the worst case the eyeballs cannot be moved at all. In addition, the pressure in the orbit increases due to the inflammation and swelling, which can lead to headaches.

The treatment of an orbital inflammation depends on the cause of the disease. Generally, an inflammation is treated with anti-inflammatory drugs such as ibuprofen. If endocrine orbitopathy is present, special medications, so-called thyrostatics or thyroid blockers, are used.

In severe cases, glucocorticoids are used to reduce the inflammation. Rheumatic diseases in which the eye is also affected are also frequently treated with these drugs. Orbitaphlegmons are serious diseases that can lead to serious complications and even blindness or death.

Therefore, even the suspicion of a purulent orbital inflammation is sufficient to start antibiotic therapy immediately. This is administered in the form of an infusion. In most cases, a surgical procedure is also required to drain off the accumulation of pus.

An ophthalmologist should be consulted immediately if there is any suspicion of an orbital inflammation. The doctor will ask the patient questions about his medical history, previous illnesses and current complaints. He then performs an eye examination.

By means of a blood test the inflammation parameters in the body can be examined. Occasionally it may be necessary to take a tissue sample from the eye socket in order to examine it under a microscope. In some cases, it is also necessary to use magnetic resonance imaging (MRI) or computed tomography (CT) imaging of the orbit.

In the clinical picture of an endocrine orbitopathy, an increase in the size of the structures within the orbit is characteristically accompanied by a strong protrusion of the eyeballs (“bulging eyes”, medically exophthalmos). Often patients also suffer from palpitations and the enlarged thyroid gland causes a goiter. The exophthalmos can occur on one or both sides.

Inflammation of the eye socket can occur as a result of a bacterial infection. Often, a paranasal sinus infection spreads to the orbit and a purulent inflammation of the orbit occurs. An accumulation of pus within the orbit is medically called orbital aphlegmon.

In general, almost every infection of the head and facial area can spread the bacteria to the orbit and lead to an inflammation there. This applies, for example, to inflammation of the root of a tooth or a grain of barley (hordeolum) on the inside of the eyelid. Systemic inflammations, i.e. diseases that affect the entire body, can also spread to the eye and thus cause an eye cavity inflammation.

These include above all rheumatic diseases such as Wegener’s granulomatosis (granulomatosis with polyangiitis). In this disease the small blood vessels in the entire body become inflamed, a condition known as vasculitis. Other causes of orbital inflammation include tumours of the orbit, inflammation of the optic nerve (optic neuritis) or inflammation of the eye muscle (ocular myositis).

Thyroid gland diseases are also clinically relevant in orbital inflammation. Graves’ disease is an autoimmune disease that leads to hyperthyroidism. As a result, the orbit of the eye can become inflamed and a so-called endocrine orbitopathy develops.

The duration of an orbititis depends on the extent of the inflammation. The more the inflammation has spread, the more difficult it is to treat and the longer it takes for complete healing to occur. At least one week should be expected before the inflammation has subsided completely.