ORBITAL PERIOSTITIS

Prepared by - Ayushi soni

Group .no -Gm-20-077
 Introduction

Periorbital periostitis is a medical condition

characterized by inflammation of the
periosteum, which is the connective tissue
that covers the bones surrounding the eye
socket (orbit). This condition can lead to
various symptoms, including pain, swelling,
and redness around the eye. It is typically
associated with infections, autoimmune
diseases, or trauma to the orbital region.
Periorbital periostitis requires medical
evaluation and treatment, often involving
antibiotics or anti-inflammatory
medications, depending on the underlying
cause. I
ETIOLOGY
• Periorbital periostitis can have various underlying causes, and the etiology may differ
from one case to another. Some common causes and contributing factors include:

• 1. Infection: Periorbital periostitis can be caused by bacterial, viral, or fungal infections,

with sinusitis being a common source of infection that can spread to the periosteum
around the eye socket.

• 2. Trauma: A direct injury to the orbital region, such as a fracture or blunt force trauma,
can lead to inflammation of the periosteum.

• 3. Autoimmune diseases: Conditions like thyroid eye disease (Graves' disease)

• 4. Allergies: Severe allergic reactions or inflammatory responses to allergens can also

lead to periorbital periostitis in some cases.

• 5. Dental infections: Infections in the upper teeth, particularly the molars, can spread to
the periorbital region and cause periostitis.

• 6. Idiopathic: In some cases, the exact cause of periorbital periostitis remains unknown,
and it may be referred to as idiopathic periostitis.
Infections
• Infections can cause periorbital periostitis through a process of inflammation and the spread of pathogens to
the periosteum, which is the connective tissue covering the bones in the orbital region. Here's how it typically
occurs:

• 1. Invasion of Pathogens:
Infections, such as bacterial, viral, or fungal infections, can occur in various nearby structures, including the
sinuses, upper respiratory tract, or even the eyelids. These pathogens can proliferate and cause localized
inflammation.

• 2. Inflammatory Response:
The presence of pathogens triggers an immune response, leading to inflammation in the affected area. This
inflammation can extend to the periosteum, which is rich in blood vessels and sensitive to changes in the
surrounding tissue.

• 3. Periosteal Involvement:
Inflammation in the periosteum (periostitis) results in pain, swelling, and redness around the eye socket. The
periosteum becomes thickened and can cause pressure on the eye, leading to discomfort and other symptoms.

• 4. Spread of Infection:
In severe cases, the infection can further spread from the periosteum to adjacent tissues, potentially causing
more significant complications, such as orbital cellulitis or abscess formation.

• The treatment of periorbital periostitis caused by infection typically involves addressing the underlying
infection. This may include antibiotics for bacterial infections, antiviral medications for viral infections, or
antifungal medications for fungal infections. Prompt diagnosis and treatment are essential to prevent the
infection from spreading and causing more severe issues in the orbital region.
Traumal cause
• Trauma, such as a direct blow or injury to the orbital region, can lead to periorbital periostitis through
the following mechanism

• 1. Direct Impact:
A traumatic event, like a fall, sports injury, or accident, can result in a direct impact to the area around the
eye socket. This impact can damage the periosteum, leading to inflammation and periostitis.

• 2. Inflammatory Response:
In response to the trauma, the body's natural defense mechanisms trigger an inflammatory response. This
inflammation can involve the periosteum and the surrounding tissues, causing pain, swelling, and redness
in the periorbital area.

• 3. Bone Fracture
Severe trauma can result in bone fractures in the orbital region, and the periosteum covers these bones.
Fractures can disrupt the periosteum and lead to periostitis as part of the healing process.

• 4. Hematoma Formation:
The trauma can also cause the collection of blood within the periorbital tissues (hematoma). The presence
of a hematoma can further irritate the periosteum and contribute to inflammation and discomfort.

• Treatment for periorbital periostitis due to trauma involves assessing the extent of the injury and
addressing any fractures or hematomas, if present. Management may include immobilization, pain relief,
and sometimes surgical intervention, depending on the severity of the trauma. It's important to seek
medical attention promptly if you suspect a traumatic injury to the orbital region to prevent
complications and ensure proper healing.
Fracture of eye orbit
Graves disease
• Graves orbitopathy occurs in patients with Graves
disease and is an autoimmune disease of retro-ocular
tissue.
• Graves orbitopathy (Graves eye disease or Graves
ophthalmopathy) is a constellation of signs and
symptoms related to the orbit and surrounding tissues
in patients with Graves disease. It can also sporadically
occur in patients who are euthyroid or even hypothyroid
as a result of chronic thyroiditis.
• It is an autoimmune process affecting retro-ocular
tissues. In its severe form, it can be sight-threatening;
thus, prompt evaluation and timely referral and
management become of utmost importance.
Allergens
• Allergies can potentially cause periorbital periostitis through a complex inflammatory response.

• 1. **Allergen Exposure:**
When an individual with allergies is exposed to an allergen, such as pollen, dust mites, pet dander, or
certain foods, their immune system may perceive the allergen as a threat.

• 2. **Immune Response:**
The immune system releases antibodies, particularly immunoglobulin E (IgE), in response to the
allergen. These antibodies trigger the release of various inflammatory substances, including histamines.

• 3. **Histamine Release:**
Histamines and other inflammatory chemicals can cause blood vessels in the affected area to become
more permeable, leading to swelling and redness. In the periorbital region, this can result in
inflammation of the periosteum (periostitis).

• 4. **Symptoms:**
Allergic periostitis may lead to symptoms such as periorbital swelling, redness, pain, and discomfort,
similar to other causes of periostitis.

• While allergies can contribute to periorbital periostitis, it's important to note that this is less common
than other causes like infection or trauma. Management typically involves identifying and avoiding
the allergen triggering the response and using antihistamines or other allergy medications to alleviate
symptoms.
Dental causes
• dental infection or abscess in the upper jaw can
spread and cause inflammation in the periorbital
area. This is because the upper jawbone is close to
the eye socket. In such cases, the infection can
track along the path of least resistance, causing
swelling and discomfort in the periorbital region.
SYMPTOMS
• Periorbital periostitis, which is the inflammation of the periosteum around the eye, can
present with various symptoms. These symptoms may include:

• 1. Periorbital swelling: Swelling around the eye, which can cause puffiness and
discomfort

• 2. Tenderness: The area around the eye may be tender to the touch.

• 3. Redness: The skin around the eye may appear red or inflamed.

• 4. Pain: Periorbital periostitis can be painful, especially when touching the affected area.

• 5. Fever: In some cases, an underlying infection may cause a fever.

• 6. Changes in vision: Although less common, periorbital periostitis can lead to changes in
vision if the inflammation affects the eye's function or the surrounding tissues.

• It's important to note that these symptoms can vary in severity and may be caused by
different underlying conditions. If you experience any of these symptoms, it's advisable to
seek medical attention for a proper evaluation and diagnosis to determine the underlying
cause and receive appropriate treatment.
Diagnosis
• Diagnosing periorbital periostitis typically involves a combination of medical
history, physical examination, and diagnostic tests. Here are the steps typically
taken in the diagnosis:

• 1. Medical History: Your healthcare provider will ask about your symptoms,
when they started, and any potential triggers or underlying medical conditions.
• 2. Physical Examination: A thorough physical examination will be conducted to
assess the swelling, tenderness, and any other physical signs in the periorbital
area.
• 3. Imaging: To confirm the diagnosis and assess the extent of the condition,
imaging studies such as a CT (computed tomography) scan or MRI (magnetic
resonance imaging) may be performed. These imaging techniques can provide
detailed views of the affected area.
• 4. Blood Tests: Blood tests may be ordered to check for signs of infection or
inflammation, which can help determine the underlying cause.
• 5. Biopsy: In some cases, a tissue biopsy may be necessary to rule out other
conditions or infections and confirm the presence of periostitis.
• Once the diagnosis is confirmed, the underlying cause of periorbital periostitis
will be determined, and treatment will be based on addressing that cause. This
may involve antibiotics for infections, anti-inflammatory medications for
inflammatory conditions, or other appropriate treatments as needed.
• The treatment for periorbital periostitis depends on the underlying cause, as periorbital
periostitis is often a secondary condition resulting from another issue, such as infection
or inflammation. Here are some general treatment approaches:
• 1. Antibiotics: If the periostitis is due to a bacterial infection, antibiotics are typically
prescribed to combat the infection. The choice of antibiotics will be based on the type of
bacteria causing the infection and its sensitivity to specific antibiotics.
• 2. Anti-Inflammatory Medications: In cases of non-infectious inflammation, non-
steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids may be used to reduce
inflammation and relieve pain.
• 3. Pain Management: Over-the-counter pain relievers may be recommended to
manage pain and discomfort.
• 4. Addressing the Underlying Cause: Treating the root cause of periorbital periostitis is
essential. This may involve dental treatment, such as addressing dental infections or
abscesses, or managing systemic conditions that are contributing to the inflammation.
• 5. Warm Compresses: Applying warm compresses to the affected area can help reduce
swelling and ease discomfort.
• 6. Rest and Elevation: Resting and keeping the head elevated can also aid in reducing
swelling.
• It's important to consult with a healthcare provider, such as an ophthalmologist, oral
surgeon, or general practitioner, for an accurate diagnosis and appropriate treatment
plan. The specific treatment will depend on the individual's condition and the
underlying cause of periorbital periostitis.