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