What Causes Pus in the Eye?

Orbital abscess is an abscess formed by accumulation of necrotic tissue and pyogenic bacteria in orbital fat. It is an inflammatory reaction. Abscesses and surrounding tissues can cause severe damage to the orbital and eye structures. Early diagnosis and timely treatment can reduce eye complications. Improper treatment or improper treatment can cause severe visual impairment and even blindness, or it can lead to death of patients.

Basic Information

English name

orbital abscess

Visiting department

Ophthalmology

Common locations

eye

Common causes

Sinus inflammation, periodontitis and apical inflammation, facial and eyelid bloatedness, acute dacryocystitis, etc .; trauma and bloodstream infections

Common symptoms

Eyelid congestion, edema, palpebral fissure reduction, conjunctival congestion, edema, severe eyelid fissure cannot be closed, eyeball protrusion, eye movement disorders, etc.

Causes of orbital abscess

1. Peripheral structure inflammation spread

Is the most common cause of disease. Mainly sinus inflammation, periodontitis and apical inflammation, facial and eyelid bloatedness, acute dacryocystitis and so on.

2. Trauma directly infects the orbit

When an orbital perforation injury occurs, the wound is improperly handled, and pyogenic bacteria can be directly infected, forming cellulitis, and then an intraorbital abscess. Orbital foreign bodies that are not removed in time can also cause the formation of intraorbital abscesses.

3. Hematogenous infections

Purulent lesions in other parts of the body migrate into the orbit through blood, or the inflammation of the orbit is affected by sepsis.

Orbital abscess clinical manifestations

Eyelid congestion, edema, conjunctival congestion, and edema can be seen in the eye. In severe cases, the eyelid can not be closed. Prolonged prolapse of the conjunctiva can cause dry necrosis. In severe cases, the eyeballs are prominent and the eye movements are impaired. Increased orbital pressure and intraorbital inflammation can cause pupillary reflex impairment, decreased vision, and even darkening. May have systemic manifestations such as fever, chills, and general discomfort.

Orbital abscess

Peripheral blood test

There may be elevated white blood cell counts, mainly neutrophils. The puncture aspirate or pus from the fistula for bacterial culture can confirm the species of infected bacteria.

2.CT scan

Round or irregular high-density ring shadows are seen in the orbit, and the border is clear, which can be accompanied by increased peripheral fat density. Increased density of the sinuses, thickening of the mucous membranes, and sometimes visible fluid levels, suggesting that abscesses are secondary to sinusitis. CT can also detect the location of foreign bodies, especially metal foreign bodies, and plant-based foreign bodies often show low-density shadows.

3.MRI scan

The location and shape of the intraorbital abscess and sinusitis are clearer than CT. The abscess in the abscess contains more necrotic components, which makes T1WI a high signal and T2WI a high signal. The abscess wall can be strengthened during enhanced scanning. MRI can show plant-derived foreign bodies with low or no signal.

4. Intraorbital puncture

If necessary, intraorbital abscess puncture can be performed, bacterial culture of pus and susceptibility test.

Orbital abscess diagnosis

According to the clinical manifestations of intraorbital abscesses and the results of imaging studies, a general diagnosis can be made.

Differential diagnosis of orbital abscess

Orbital inflammatory pseudotumor

Immune abnormalities are the cause of the disease, which can be acute onset, normal white blood cells and neutrophils, no abscess formation on imaging examination, and no response to antibiotic treatment.

2. Orbital rhabdomyosarcoma

Rapid development, more common in children under 10 years of age.

3. Orbital lymphoma

Occurs in the elderly. Congestion and edema may occur on the eyelids, drooping of the upper eyelids, obvious edema of conjunctiva, protruding eyeballs, and eye movement disorders. CT and MRI scans show that solid changes in the orbital lesions are present, while intraorbital abscesses are cystic changes, which can be used for identification.

Orbital abscess treatment

1. Use broad-spectrum antibiotics throughout the body to control infection.

2. According to the results of imaging examination, incision and drainage can be performed on the clearly formed abscess, and bacterial culture and drug sensitivity tests can be performed on the pus.

3. If any foreign body remains, open orbital foreign body removal should be performed to help control inflammation.

4. When sinus inflammation is present, you can ask an otolaryngologist for sinus drainage.