Management of Orbital Cellulitis with Periorbital Abscess and Rhinosinusitis in Older Patient with Type 2 Diabetes Mellitus: A Case Series

Abstract Background In this observational case series, we describe two cases of orbital cellulitis with periorbital abscess and rhinosinusitis in patients with type 2 diabetes mellitus. Orbital cellulitis is an ocular emergency because it’s not only sight- but also life-threatening if not properly treated. Case Report Two female patients presented to our hospital with progressive swelling and pain in the right eye. Ophthalmological examination of both patients showed diffuse inflammatory signs from the upper eyelid to the lower eyelid with pus production. A multidisciplinary approach including ENT, dermato-venereology, internist-endocrinologist, dentistry, and plastic reconstructive surgery departments was accomplished to achieve proper management. Both patients were diagnosed with orbital cellulitis, periorbital abscess, rhinosinusitis, diabetes mellitus, and dental problem. In the first case, initial empiric antibiotic therapy was given for two days, but there was no clinical improvement. Functional Endoscopic Sinus Surgery and debridement were performed on the 4th day of hospitalization. There was a significant improvement after the surgery and a new regimen of antibiotics (piperacillin-sulbactam 4x4.5 g intravenously and clindamycin 3x600 mg orally). The pus culture showed Klebsiella pneumonia and Enterobacter cloacae which were sensitive to piperacillin-sulbactam. In the second case, improvement was significant with given antibiotics medication (ampicillin-sulbactam 4x1.5 gram, and metronidazole 3x500 mg intravenously). The pus culture revealed no growth of bacteria, but gram-positive cocci were positive in the gram staining examination. Conclusion Multidisciplinary team plays a critical role in managing orbital cellulitis with periorbital abscess, rhinosinusitis, and type 2 diabetes mellitus to achieve a better prognosis and visual outcome.