Les cellulites orbitaires: approche diagnostique, thérapeutique et pronostique dans un centre de référence à Tunis, Tunisie (une étude rétrospective sur 109 cas)

Orbital cellulitis is a rare disease. Two anatomo-clinical forms can be distinguished: a preseptal “benign” form and a retroseptal “severe” form. The purpose of this study was to analyze the epidemiological, clinical, therapeutic and prognostic profile of orbital cellulitis in a third-line Hospital in Tunis, Tunisia. We conducted a retrospective study involving 109 patients hospitalized for orbital cellulitis. Two groups were distinguished: the retroseptal cellulitis group including 42 patients (38.5%) and the preseptal cellulitis group including 67 patients (61.5%). The average age of patients was 27.1 ± 34.8 years. The sex ratio M/F was 0.84 (45.9% of male patients). Acute sinusitis was the most frequently identified portal for retroseptal cellulitis entry (35.7%, n=15), while acute dacryocystitis was the most common cause of preseptal cellulitis (23.9%, n=16). Diabetes, non-functioning eye and prior use of non-steroidal anti-inflammatory drugs were associated with retroseptal cellulitis (p=0.007, p=0.022 and p=0.014 respectively). All patients received systemic antibiotic therapy. Ten patients (23.8%) of the retro-septal cellulitis group and 5 patients (7.46%) of the preseptal cellulitis group underwent surgery. Nine cases of blindness (8.2%), a case of septic shock and a case of death were reported. Poor prognostic factors were a time of consultation > 7 days (aOR = 4.277, 95% CI = 2.504-32.426, p = 0.006) and Chandler stage>III (aOR = 7.009, 95% CI = 1.69-51.839, p = 0.029). In developing countries and especially in Tunisia, orbital cellulitis can be sight threatening or even life-threatening. Early management could lead to a favorable outcome without sequelae.