• STANA Daniela Emergency University Hospital Bucharest, Romania
  • ARDELEANU Ioana Sonia ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania


Orbital cellulitis, a relatively infrequent infection of the ocular adnexa and orbital adipose tissue, is an ophthalmic emergency. In the absence of prompt anti-infective treatment, the spread of the infectious process can quickly lead to serious complications: vision loss, cavernous sinus thrombophlebitis, meningitis, intracranial septic spreads, and even death. In the adult population, the frequency of orbital complications from sinus infection ranges from 0.5% to 3.9%, and that of odontogenic orbital inflammation is even more infrequent. We report the case of a 56-year-old female patient with type 2 diabetes admitted in emergency for left exophthalmos, with painful limitation of eye movements and blurred vision in her left eye (LE). Fundus examination revealed in the LE significant optic disc edema, flame-shaped peripapillary hemorrhages, and dilated tortuous retinal veins. Due to the relative subacute course of proptosis and the mild orbital inflammatory signs, the diagnostic challenge was to differentiate between orbital cellulitis and a pseudo inflammatory sign that could be associated to an orbital lymphoma or other malignancies. Imaging findings were suggestive of odontogenic orbital cellulitis. A prompt intravenous antibiotic therapy was initiated, followed by ENT surgery of the infected tooth and maxillary sinusitis. The outcome was favorable, with progressive recovery of visual function. Conclusion: Odontogenic orbital cellulitis is an ocular emergency that is best managed by a multidisciplinary team consisting of an ophthalmologist, otolaryngologist, infectious diseases specialist and neurosurgeon. Prompt multimodal therapeutic approach, including imaging investigations, antibiotic therapy, and surgical treatment can avoid serious complications and lead to full recovery.

Author Biography

ARDELEANU Ioana Sonia, ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Alessandrescu-Rusescu” INSMC Bucharest, Romania


1. Chaudhry IA, Al-Rashed W, Arat YO. The hot orbit: orbital cellulitis. Middle East Afr J Ophthalmol 2012; 19(1): 34-42 / doi: 10.4103/0974-9233.92114.
2. Costan VV, Bogdănici CM, Gheorghe L, et al. Odontogenic orbital inflammation. Rom J Ophthalmol 2020; 64(2): 116-121.
3. Hegde R, Sundar G. Orbital cellulitis. A review. TNOA J Ophthalmic Sci Res 2017; 55: 211-219.
4. Serban D, Smarandache AM, Cristian D, Tudor C, Duta L, Dascalu AM. Medical errors and patient safety culture - shifting the healthcare paradigm in Romanian hospitals. Rom J Leg Med 2020; 28(2): 195-201.
5. Serban D, Vancea G, Balasescu SA, Socea B, Tudor C, Dascalu AM. Informed consent in all surgical specialties: from legal obligation to patient satisfaction, Rom J Leg Med 2020; 28(3): 317-321.
6. Lizette Mowatt (November 5th, 2018). Orbital Cellulitis, Challenging Issues on Paranasal Sinuses, Tang-Chuan Wang IntechOpen / doi: 10.5772/intechopen.79983. Available from: https://www.
intechopen.com/books/ challenging-issues-on-paranasal-sinuses/orbital-cellulitis-1
7. Rothschild MI, Pinheiro-Neto CD, Rubinstein TJ. Odontogenic Abscess with Orbital Extension Through the Inferior Orbital Fissure Treated with Bony Decompression. Ophthalmic Plast Reconstr Surg 2020; 36(5): e131-e134.
8. Flam JO, Platt MP, Sobel R, Devaiah AK, Brook CD. Association of oral flora with orbital complica-tions of acute sinusitis. American Journal of Rhinology Allergy 2016; 30(4): 257-260.
9. Li E, Distefano A, Sohrab M. Necrotizing Orbital Cellulitis Secondary to Odontogenic Streptococcus constellatus. Ophthalmic Plast Reconstr Surg 2018; 34(5): e160-e162.
10. Behrens AW, Wang H, Pemberton JD and Kumar M. A Rare Case of Odontogenic Orbital Cellulitis Leading to Septic Cavernous Sinus Thrombosis and Review of Literature. J Clin Ophthalmol and Op-tometry 2018; 2(1): 104.
11. Allegrini D, Reposi S, Nocerino E, Pece A. Odontogenic orbital cellulitis associated with cavernous sinus thrombosis and pulmonary embolism: a case report. Journal of Medical Case Reports 2017; 164: 11.
12. Stead TG, Retana A, Houck J, Sleigh BC, Ganti L. Preseptal and Postseptal Orbital Cellulitis of Odontogenic Origin. Cureus 2019; 11(7): e5087.
13. Youssef OH, Stefanyszyn MA, Bilyk JR. Odontogenic orbital cellulitis. Ophthal Plast Reconstr Surg 2008; 24: 29-35.
14. Procacci P, Zangani A, Rossetto A, et al. Odontogenic orbital abscess: a case report and review of literature. Oral Maxillofac Surg 2017; 21: 271-279.
15. Park CH, Jee DH, La TY. A case of odontogenic orbital cellulitis causing blindness by severe tension orbit. J Korean Med Sci 2013; 28(2): 340-343.
16. Danishyar A, Sergent SR. Orbital Cellulitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing 2021, PMID: 29939678.
17. Tsirouki T, Dastiridou AI, Ibánez Flores N, et al. Orbital cellulitis. Surv Ophthalmol 2018; 63(4): 534-553.
18. Stead TG, Retana A, Houck J, Sleigh BC, Ganti L. Preseptal and Postseptal Orbital Cellulitis of Odontogenic Origin. Cureus 2019; 11(7): e5087.
19. Garcia GJ, Harris GJ. Criteria from nonsurgical management of subperiosteal abscess of the orbit: analysis of outcomes 1988-1998. Ophthalmology 2000; 107: 1454-1458.
20. El-Beltag Y, Hamid TA, Mohamed H, Hasaballah S. Orbital complications following sinusitis still a problem: Our experience and results. Egyptian Journal of Ear, Nose, Throat and Allied Sciences 2014; 15(3): 189-195.
21. Alius C, Tudor C, Badiu CD, et al. Indocyanine Green-Enhanced Colorectal Surgery-between Being Superfluous and Being a Game-Changer. Diagnostics (Basel) 2020; 10(10): E742 / doi: 10.3390/ di-agnostics10100742.
22. Serban D, Smarandache CG, Tudor C, Duta LN, Dascalu AM, Aliuș C. Laparoscopic Surgery in COVID-19 Era-Safety and Ethical Issues. Diagnostics (Basel) 2020; 10(9): E673 / doi: 10.3390/ di-agnostics10090673.
23. Dascalu AM, Tudosie MS, Smarandache GC, Serban D. Impact of the COVID-19 pandemic upon the ophthalmological clinical practice. Rom J Legal Med 2020; 28(1): 96-100.
24. Hainarosie R, Zainea V, Rusescu A, et al. Management of infectious complications in diabetes mellitus patients‎, Romanian Journal of Military Medicine 2019; 122(1): 46-51.
25. Dobrică EC, Găman MA, Cozma MA, Bratu OG, Pantea Stoian A, Diaconu CC. Polypharmacy in Type 2 Diabetes Mellitus: Insights from an Internal Medicine Department. Medicina (Kaunas) 2019; 55(8): 436 / doi: 10.3390/medicina55080436.