Coronavirus Disease 2019 as a Possible Cause of Severe Orbital Cellulitis

 

Published on MedED:  2 September 2021
Type of article: Review: Patient Case Study

MedED Catalogue Reference: MOT002
Compiler: Linda Ravenhill

Sources: Journal of Craniofacial SurgeryMedExpress 
 

This quick clinical study published in the Journal of Craniofacial Surgery describes what may be the first reported case of orbital cellulitis as a complication of Corona virus infection.1 Previous studies had described ocular repercussions, with eye symptoms including tearing and eye pain. In contrast, a US paper had reported sinus infection with orbital cellulitis as a typical condition associated with COVID-19. 2 However, the complication is not listed as common.

The reported case published in July 2021 describes a 28-year-old male patient who was admitted to the hospital in October 2020, presenting with progressive orbital swelling on the left side. On history, he reported that, 13 days prior to the consult, he had experienced progressive fatigue and an absence of smell and taste. In the following 2 days, his symptoms worsened. He developed a frontal headache and the beginning of a left periorbital swelling and ipsilateral epiphora.1

At this stage, he sought medical attention at his local emergency department, where he tested positive for COVID-19, with concomitant sinusitis. He was commenced on a sinus treatment protocol. 1

While his COVID-related symptoms improved, the orbital infection did not. Four days later, he returned to the local hospital and was transferred to University Hospital in Londrina-PR/Brazil and was seen by the Oral and Maxillofacial Surgery team. 1

The team's findings were of significant peri-orbital oedema on palpation, hyperemia and associated local heat without evidence of drainage or fistulae. There was significant swelling of the eyelid opening, making eye examination difficult. Secretions between the eyelids were noted together with slight hypoglobe and proptosis of left globe, and movement restriction. However, visual acuity was intact, and the pupils were fully responsive. 1

CT Imaging examination revealed bilateral sinus veiling of the maxillary, frontal and ethmoidal sinus together with a purulent collection seen in the upper-superior compartment of the left globe, causing it to move inferiorly against the orbital floor. 1

Based on the clinical examination and imaging findings, a diagnosis of orbital cellulitis secondary to pansinusitis related to COVID-19 was reached. The patient underwent emergency surgery for drainage of the left periorbit. Samples from the drainage returned a positive result for COVID-19. The patient recovered uneventfully in the proceeding 30 days. 1
 
The study concludes that while it is not clear whether COVID-19 itself is the contributory factor to the pathogenesis or the cellulitis, the time of symptom onset and the absence of previous symptoms of chronic sinus disease, raises the possibility that infection by the virus was a contributory factor to the secondary orbital infections. 1

Health professionals involved in the care of COVID 19 cases should note these findings when presented with such cases. 1

 

 


References:
1.Carvalho, Vinicius Almeida DDS; Vergínio, Vinícius Eduardo de Oliveira DDS; Brito, Gabriel Conceição DDS; Pereira-Stabile, Cecilia Luiz DDS, PhD; Stabile, Glaykon Alex Vitti DDS, PhD Coronavirus Disease 2019 as a Possible Cause of Severe Orbital Cellulitis, Journal of Craniofacial Surgery: July 23, 2021 - Volume - Issue - doi: 10.1097/SCS.0000000000007826
2.Wolters Kluwer Health. First report of COVID-19 orbital involvement, Medical Express. Accessed 27 August. July 27,2021 Retrieved from https://medicalxpress.com/news/2021-07-covid-orbital-involvement.html
 
Contributor: Linda Ravenhill
Linda Ravenhill is a medical professional with an MA in Journalism. She has worked in the medical, technology and digital development spaces for over 25 years, & has a particular interest in the impact of technology on the delivery of healthcare in the Sub-Saharan Africa region.

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