Orbital cellulitis

Definition
Orbital cellulitis is an acute infection of the tissues immediately surrounding the eye.

Causes, incidence, and risk factors

Orbital cellulitis is a dangerous infection with potentially serious complications. It is usually caused by a bacterial infection from the sinuses (ethmoid or para-nasal). Other causes are a stye on the eyelid, recent trauma to the eyelid including bug bites, or a foreign object.

In children, orbital cellulitis is usually from a sinus infection and due to the organism Hemophilus influenzae. Other organisms such as Staphlococcus aureus, Streptococcus pneumoniae, and Beta hemolytic streptococci may also cause this condition.

Infants and children up through age 6 to 7 years-old seem to be particularly susceptible to infection with Hemophilus influenzae, and are most at risk. The incidence of severe disease has decreased steadily since the introduction of HiB vaccine (Hemophilus influenzae B). Risk factors include sinus infections or injury to the eyelid including bug bites.

Symptoms

     
  • Fever, generally 102 degrees F or greater.  
  • Painful swelling of upper and lower lids (upper is usually greater).  
  • Eyelid appears shiny and is red or purple in color.  
  • Infant or child is acutely ill or toxic.  
  • Eye pain especially with movement.  
  • Decreased vision (because the lid is swollen over the eye).  
  • Eyes, bulging (forward displacement of the eye).  
  • Swelling of the eyelids (see Facial swelling).  
  • General malaise.  
  • Restricted or painful eye movements.

Signs and tests
Tests commonly include:

     
  • A CBC (complete blood count)  
  • Blood culture and sensitivity  
  • A spinal tap in extremely sick children

Other tests may include:

     
  • An X-ray of the sinuses and orbit  
  • A CT scan or MRI of the sinuses and orbit  
  • A culture of eye drainage  
  • A culture of nose drainage  
  • A throat culture  
  • A blood culture

Treatment
Hospitalization is usually required. Treatment consists of IV fluids with antibiotics. Surgical drainage of an abscess may be necessary. These infections can progress rapidly, and they must be carefully followed every few hours.

Expectations (prognosis)
With early recognition and treatment, the patient can be expected to recover fully.

Complications

     
  • Cavernous sinus thrombosis  
  • Hearing loss  
  • Septicemia or blood infection  
  • Meningitis  
  • Optic nerve damage and loss of vision

Calling your health care provider
This condition is considered a major ophthalmologic emergency that requires immediate treatment. Call your physician if your child exhibits any swelling of the eyelid, especially if it is associated with fever.

Prevention
Immunization with HiB vaccine according to recommended schedules generally will prevent most Hemophilus infection in children. Young children in the same household who have been exposed may receive the prophylactic antibiotic Rifampin, although this generally is reserved for siblings exposed to other Hemophilus diseases such as Meningitis and septicemia.

Proper evaluation and early treatment of sinus, dental, or other infections may prevent the spread of infection to the eye(s).

Johns Hopkins patient information

Last revised: December 4, 2012
by Harutyun Medina, M.D.

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