Some diseases are quite rare, but if they appear, they bring a huge number of problems. Such a pathology can be attributed to phlegmon of the eye. This concept combines several diseases that severely affect the quality of life and require immediate medical attention.
The frequency of the disease is very low, occurs only in 1% of the entire population of the planet. However, if untreated, pus that accumulates around the eye can enter the cranial cavity and cause meningitis or vascular thrombosis, which is a 20% chance of death.
About the disease
What is phlegmon eyes? The disease is also called orbital cellulitis, it manifests itself in diffuse inflammation of the orbital fiber. In parallel with the external manifestations of the patient’s illness, headaches, a vomiting reflex, and febrile temperature increase. Swelling of the eyelid appears, the mobility of the eye is limited, and visual acuity decreases.
Kinds
Doctors distinguish three types of pathology:
- Phlegmon orbits of the eye or eye socket. In this case, the inflammatory process develops in the fiber of the organ of vision, which leads to its melting. The disease develops rapidly, after 24 hours the skin color clearly changes, swelling appears and the eye protrudes, exophthalmos begins, with the disappearance of mobility. Usually, the patient cannot open the affected organ; visual acuity decreases.
- Phlegmon of the century. With this diagnosis, the inflammatory process is localized on the eyelid, and not in the fiber, which it does not affect at all. In the process of development, a cavity appears in which fluid accumulates, and pus is visible through the skin. This type of disease is also characterized by visual impairment. After opening the purulent bag, the problem completely disappears.
- Phlegmon of the lacrimal sac. As the name implies, the problem occurs in the lacrimal sac, the skin around which becomes crimson and swelling appears. There is a clear narrowing of the palpebral fissure. The inflammatory process can cover nearby tissues, including the wings of the nose. As a rule, an abscess is opened on its own, and all the pus comes out through the hole. However, another development is possible - the appearance of a fistula through which pus continues to stand out.
Despite the fact that the phlegmon of the eye, eyelid or lacrimal sac can open itself, nevertheless, a visit to a doctor is necessary, this is necessary so that pus does not get into the bloodstream or skull tissue.
Why does the disease appear?
One of the main causes of the appearance of pathology is infection of the eye after an injury or the penetration of foreign bodies into the orbit. Other reasons include:
- boils or barley;
- purulent sinusitis or dacryocystitis;
- systemic diseases, such as flu or scarlet fever.
Often, phlegmon of the eye manifests itself in the form of thrombophlebitis of the small veins of the orbit. In this case, there are many abscesses, which merge over time, and one large abscess forms.
The disease can appear against the background of a disease in the dentofacial system, it can be a periodontal abscess or osteomyelitis of the upper jaw. And in 70% of cases it is a consequence of sinusitis. This complication is also characteristic of ethmoiditis.
The appearance of pathology is possible against the background of an animal or insect bite, wounds on the hands or eyelids.
Causative agents of the disease
If phlegmon is a complication after sinusitis, then Streptococcus pneumoniae is likely to be the causative agent of the disease.
After injuries, the eye usually affects Staphylococcus aureus and S. Pyogenes. Against the background of vaccination, a pathogen such as Haemophilus influenzae type B almost completely disappeared.
Pathogens penetrate the eye through the facial veins and through the veins of the orbit, which do not have a valve. The type of pathogen does not depend on the age of the patient, but only on the causes of the inflammatory process.
Clinical picture
Most often, the disease manifests itself in one eye. Phlegmon eye is characterized by an acute form at the initial stage. Along with inflammation, the patient suffers from a headache, a damaged eye hurts. General signs of intoxication are felt, the eyelids are red, and the eye itself becomes motionless. The onset of exophthalmoma and chemosis on the conjunctiva is possible. Vision is significantly impaired.
If the disease is accompanied by osteitis or periostitis of the orbital walls, then the displacement of the eyeball is possible.
The likelihood of neuritis is high if the optic nerve is pulled into the inflammatory process, with further development of vein thrombosis and congestive processes in the retina. As a result of trophic changes, keratitis develops, and possibly a purulent retinal ulcer. Atrophy of the eye may appear against the background of the transition of the inflammatory process to the choroid, retina.
The inflammatory process, which developed only on the orbit, can open itself, and pus exit through the conjunctiva or skin. Such an outcome is considered relatively favorable.
The most dangerous outcome is the development of sepsis with the transition of pus to the brain or paranasal sinuses. In such cases, death is possible.
Stages of the disease
With timely and adequate treatment of phlegmon of the eye, it is possible to prevent the transition from one stage of the disease to another. In general, several stages of the development of pathology are distinguished:
- Preseptal. At this stage, inflammation of the orbit and eyelids occurs. Exophthalmos is not yet very pronounced, and the mobility of the eye, and vision is still normal.
- Orbital cellulitis. At this stage, the posterior part of the orbit is involved in the process, which is a consequence of the appearance of orbital cellulite. This period is characterized by the appearance of edema, exophthalmoma and chemosis. Visual acuity decreases, and mobility is limited.
- Subperiostal abscess. In the event that pus accumulates between the bone and periobital walls of the orbit, this stage occurs, in which the bone wall collapses and an abscess appears. For this stage, hyperemia of the upper eyelid is characteristic, displacement of the eyeball is possible.
- Abscess and phlegmon. At this stage, a cavity with pus appears, limited by the pyogenic membrane.
Along with these stages, pathology can be accompanied by ophthalmoplegia, compression of nerves can occur and, as a result, blindness.
What can be the complications?
Regardless of the symptoms and causes of phlegmon of the eye, treatment of the pathology is necessary, since there is a high probability of complications and the most dangerous are:
- sepsis;
- meningitis;
- panophthalmitis;
- brain abscess
- thrombosis.
It is also dangerous when the optic nerve is involved in the process or a purulent corneal ulcer appears.
Diagnostic measures
At the first sign of eye phlegmon, you should immediately contact an ophthalmologist, dentist or otolaryngologist. The doctor first collects an anamnesis, trying to find out the presence of infectious diseases, examines the eye (ophthalmologist). You may need to have an ultrasound scan or X-ray of the orbit. Orthopantomograms and an examination of the sinuses are often required.
To evaluate the optic nerve, CT scans, exophthalmometry or biomicroscopy will be required. With this disease, the results of a general blood test are of great importance. Often blood is sown for sterility. The main thing is to clearly establish: whether phlegmon of the eye socket or eyelid develops.
Treatment
Etiology, clinic and treatment of phlegmon of the orbit of the eye require immediate hospitalization of the patient. The patient is assigned “shock” doses of antibacterial agents, detoxification therapy is carried out.
Along with antibiotics, trepanation of the orbit wall is performed. In this case, the therapy is aimed at removing pus and draining it, with washing and administering drugs.
If fluctuation is observed, then the orbitotomy procedure is performed, in which the wound canal is drained and impregnated with antibacterial agents. Oral cleaning may also be performed, which uses drug therapy to destroy the bacterial flora.
It is also possible the introduction of fortified solutions directly into the conjunctival sac, application of ointments. After the elimination of acute symptoms, physiotherapy is recommended: UV and UHF.
Forecast and Prevention
Active removal of symptoms and treatment of phlegmon of the eye at the initial stage contributes to a favorable outcome of the pathology. In some cases, after some time, even after a quality and timely treatment, strabismus, a temporary restriction of the mobility of the eyeball, and the cornea sore throat may temporarily be observed.
As preventive measures, only timely cured teeth and respiratory tract can act. It is impossible to prevent the development of purulent foci, even on the face, especially in the eyes or in the dentoalveolar region, and if they appear, then timely rehabilitation should be carried out.
If a foreign body has entered the organ of vision or there has been an injury, then antibacterial treatment should be carried out in order to prevent infectious complications.
You should never forget how important it is to maintain vision, which allows you to fully feel all the facets of life. This is a chance to choose your favorite profession and see your grandchildren. Also, one should not forget that the human body is a holistic system in which all organs and systems are interconnected, so you should monitor not only your eyesight, but also your overall health.