When a sinus infection goes wrong it can threaten your vision and your life

Sinus infection 2

 

As we reported last month, antibiotics are not necessary in the vast majority of sinusitis cases because (1) sinusitis is usually viral-driven and antibiotics don’t affect viruses, and (2) even if it is a bacterial infection, it typically clears up on its own.

But not always. There’s a rare case in which a sinus infection will cause a swollen eye and this will be a sign of an opthalmic emergency because it can quickly threaten your vision or even your life. The condition is called orbital cellulitis – swelling of a membrane in front of the eye.

It starts out as a typical viral sinus infection with nasal congestion and sinus pain. But in this case, pathogenic bacteria that are normally cleared by microscopic hairs get trapped by the buildup of gunk in the sinus. Where they multiply then invade and infect the eye, the sinus cavity’s next-door neighbor.

Here’s a clinical presentation of the condition by Maya Adams, MD, of the Stanford Medical School. The following is a partial transcript taken from her online course on infectious disease at Stanford called “Stories of Infection” (see Week 3, Bacterial Infections Part 2, Orbital Cellulitis).

 

Today we’re going to be talking about a rare case in which a common pediatric complaint, a swollen eye, is a sign of an opthalmic emergency requiring hospitalization and immediate medical attention. This seven year old girl named Irena was brought to the urgent care clinic by her mother …

Irena’s mother tells you that her daughter has been complaining of a headache just behind her forehead. She’s also had a very stuffy nose and pain in her face that gets worse when she bends forward to tie her shoelaces …

[I]t will be important to consider orbital cellulitis as a possible cause of her symptoms. Although this is … rare … in children, it’s important to rule it out because it’s an opthalmic emergency that can quickly threaten the patient’s vision or even her life …

In Irena’s case, her sinus infection allowed bacteria a back door entry into the normally protected orbital space. The orbit [eye socket] is separated from the air filled nasal sinuses only by the thin, bony structures of the skull. Irena’s mother was probably correct that her initial symptoms of nasal congestion and sinus pain were caused by a viral infection. Irena’s immune system detected the virus and attempted to deploy alternate immune pathways to eliminate it. But this led to inflammation and blockage of the normal sinus drainage pathways. The decreased mucociliary clearance that resulted meant that an important physical barrier which usually protects the host, by preventing pathogen entry, was less effective. And bacteria were able to colonize the sinuses …

Rarely in children with bacterial sinusitis, the bacteria go on to invade through the paper thin bones separating the sinuses from the orbit. This is how they were able to enter Irena’s orbit then persist and replicate there to cause her symptoms. Once the bacteria have spread into the orbit, they can cause serious complications …

Severe edema or abscess formation can also put pressure on the optic nerve or the central retinal artery, causing loss of vision …

Because of Irena’s symptoms and her history of a recent sinus infection, the attending physician in this case decides that she should be admitted to hospital …

Luckily, no abscesses are seen, so it’s unlikely that surgical intervention will be necessary. Almost immediately after arriving at the hospital, Irena is started on two IV antibiotics, a third-generation cephalosporin, and vancomycin …

After three days on IV antibiotics, Irena’s pain and swelling are much improved and her white blood cell count normalizes. On day five, she goes home on oral antibiotics to complete a three week course of treatment. … And after ten days, Irena returns to school and her mother is able to return to work.

 

One more thing. Some bacteria are resistant to cephalosporin’s and “vancomycin resistance is becoming an increasingly common problem.” What would happen to Irena if one or both her antibiotics failed to work?

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