What is the role of CT scanning in the diagnosis of periorbital infections?

Updated: Jul 31, 2018
  • Author: Bobak Zonnoor , MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Answer

Contrast-enhanced computed tomography (CT) scanning of the orbits should be performed if there is concern for orbital and subperiosteal involvement and cavernous sinus thrombosis. CT scanning also helps to distinguish sinusitis as a cause.

Indications for CT scanning include the following [61] :

  • Inability to perform a full evaluation of the eye due to edema

  • Proptosis

  • Ophthalmoplegia

  • Decreased visual acuity or color vision

  • Bilateral periorbital edema

  • Inability to exclude postseptal involvement
  • Central nervous system involvement (eg, focal neurological deficits, seizure, altered mental status)
  • Clinical deterioration or no improvement after 24-48 hours following initiation of appropriate treatment

CT scanning will show lid edema but no proptosis or "streaking" of the orbital fat, which lies posterior to the orbital septum.

Patients whose condition fails to improve after 24-36 hours of appropriate antimicrobial therapy should also have CT performed. [61]

In an attempt to better target patients needing emergent CT scanning, Rudloe et al presented a recursive partitioning model for identification of predictors of intraorbital or intracranial abscess, for use in pediatric patients with signs or symptoms of periorbital infection. [62]

Results of the study confirmed that patients with proptosis and/or pain or limitation of extraocular movements are at high risk for intraorbital abscess, though many patients with abscess do not have these predictors. The investigators also concluded, based on multivariate analysis, that the following findings can identify patients at significant risk when the obvious predictors are not present:

  • Peripheral blood neutrophil count over 10,000/μ L

  • No infectious conjunctivitis,

  • Periorbital edema

  • Age older than 3 years

  • Previous antibiotic use


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