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Orbital cellulitis is an acute infection of the tissues immediately surrounding the eye with potentially serious complications.
This condition is considered a major ophthalmologic emergency that requires immediate treatment.
Incidence; Causes & Development
Infants and children up to the age of seven seem to be particularly susceptible to infection with Hemophilus influenzae and are most at risk. The actual incidence is not reported, but it is a rare infection.
It is usually caused by a bacterial infection which typically will have spread from the ethmoid or para-nasal sinuses but may also have its origin elsewhere such as a boil on the eye or eyelid (stye), recent trauma to the eye, injury to the eyelid (including bug bites), or a foreign object.
Among children, orbital cellulitis - and the less serious infection but still important periorbital cellulitis - is most often caused by the organism Hemophilus influenzae. Other organisms such as Staphylococcus aureus, Streptococcus pneumoniae and Beta hemolytic streptococci also may cause this condition.
Signs & Symptoms
- Fever - generally 102°F or higher
- Painful swelling of upper and lower lids (upper is usually greater)
- Eyelid appears shiny, taut and is reddish or purplish in color
- Restricted eye movements.
- Eye pain, especially with movement
- Eye burning, itching and discharge)
- Swelling of the eyelids
- Decreased vision as a result of swollen eyelid
- Bulging eyes (forward displacement of the eye)
- General malaise
- In infants or children: appearing acutely ill or toxic
Diagnosis & Tests
Tests commonly include: 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.
Treatment & Prevention
Hospitalization is always required. Treatment consists of IV fluids with antibiotics. Surgical drainage of an abscess may be necessary. Proper evaluation and early treatment of sinus, dental, or other infections may prevent the spread of infection to the eye(s).
Prognosis; Complications; Seek medical attention if
With early recognition and treatment the patient can be expected to recover fully.
Complications can include:A physician should be called if a child exhibits any swelling of the eyelid, especially if it is associated with fever.
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Signs, symptoms & indicators of Orbital Cellulitis:
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GLOSSARY
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Bacteria (Bacterial, Bacterium)
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Boil (Abscess, Abscesses, Boils, Carbuncle, Carbuncles, Cystic Acne, Furuncle, Furuncles, Hidradenitis Suppurativa, Pilonidal Cyst, Pilonidal Cysts)
A localized infection deep in the skin. A boil generally starts as a reddened, tender area. Over time, the area becomes firm and hard. Eventually, the center of the abscess softens and becomes filled with white cells that the body sends to fight the infection (pus). Finally, the pus forms a "head" and drains out through the skin. A furuncle or carbuncle is an abscess in the skin caused by the bacteria Staphylococcus aureus. It can have one or more openings onto the skin and may be associated with a fever or chills. Cystic acne is a type of abscess formed when oil ducts become clogged and infected. Cystic acne is most common in the teenage years. Hidradenitis suppurativa is an illness in which there are multiple abscesses that form under the arm pits and in the groin area. These areas are a result of local inflammation of the sweat glands. A pilonidal cyst is a special kind of abscess that occurs in the crease of the buttocks. These frequently form after long trips that involve sitting.
Cellulitis
An acute inflammation of the connective tissue beneath the surface of the skin. It is more wide-spread than a localized infection as seen in an ulcer or abscess and causes the skin tissues in the infected area to become red, hot, painful and swollen.
Complete Blood Count (CBC)
A set of measurements that are generally determined by specially designed machines that analyze the different components of blood in less than a minute. The values generally included are:- White blood cell count (WBC). The number of white blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4,300 and 10,800 cells per cubic millimeter. This can also be referred to as the leukocyte count and can be expressed in international units as 4.3 - 10.8 x 10^9 cells per liter.
- Automated white cell differential. A machine-generated percentage of the different types of white blood cells, usually split into granulocytes, lymphocytes, monocytes, eosinophils, and basophils.
- Red cell count (RBC). The number of red blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4.2 - 5.9 million cells per cubic millimeter. This can also be referred to as the erythrocyte count and can be expressed in international units as 4.2 - 5.9 x 10^12 cells per liter.
- Hemoglobin (Hb). The amount of hemoglobin in a volume of blood. Normal range for hemoglobin is different between the sexes and is approximately 13 - 18 gm/dl for men and 12 - 16 for women (international units 8.1 - 11.2 millimoles/liter for men, 7.4 - 9.9 for women).
- Hematocrit (Hct). The ratio of the volume of red cells to the volume of whole blood. Normal range for hematocrit is different between the sexes and is approximately 45 - 52% for men and 37 - 48% for women.
- Mean cell volume (MCV). The average volume of a red cell. This is a calculated value derived from the hematocrit and red cell count. Normal range is 86 - 98 femtoliters.
- Mean cell hemoglobin (MCH). The average amount of hemoglobin in the average red cell. This is a calculated value derived from the measurement of hemoglobin and the red cell count. Normal range is 27 - 32 picograms.
- Mean cell hemoglobin concentration (MCHC). The average concentration of hemoglobin in a given volume of red cells. This is a calculated volume derived from the hemoglobin measurement and the hematocrit. Normal range is 32 - 36%.
- Red cell distribution width (RDW). A measurement of the variability of red cell size. Higher numbers indicate greater variation in size. Normal range is 11 - 15.
- Platelet count. The number of platelets in a volume blood. Platelets play a vital role in blood clotting. Normal range varies slightly between laboratories but is in the range of 150,000 - 400,000 per cubic millimeter (150 - 400 x 10^9 per liter).
Computerised Tomography (CAT Scan, Computed Tomography, Computerized Axial Tomography, CT Scan)
A scanning procedure using X-rays and a computer to detect abnormalities of the body's organs. This technique provides cross-sectional images of body organs, which is much clearer than those provided by conventional X-rays.
Discharge (Discharges)
A secretion, of pus for example, from a wound or bodily orifice.
Hemolytic
Promoting the breakdown of red blood cells; a normal process, hectic and skillfully balanced, the term is usually applied to excess conditions or toxic substances that degrade the bonds between healthy red blood cells and their hemoglobin coat or cause the liver and spleen to hypercatabolize otherwise healthy erythrocytes.
Intravenous Infusion (IV)
A small needle placed in the vein to assist in fluid replacement or the giving of medication.
Magnetic Resonance Imaging (MRI)
A technique used in diagnosis that combines radio waves and magnetic forces to produce detailed images of the internal structures of the body.
Malaise
A vague feeling of bodily discomfort, as at the beginning of an illness. A general sense of depression or unease.
Sepsis (Blood Poisoning, Septicemia)
Like septicemia, an infection that has moved deeply into the body, involving the subcutaneous or submucosal layers, connective tissue, lymph system, or blood. Septicemia: The presence of pathogenic bacteria or other microbes in the blood stream - a serious business, since most defenses are focused outside the bloodstream and the infection has bypassed them either due to its virulence, the depth and severity of the original focal infection or the weakened state of the body's immunity and life energy. Blood poisoning.
Sinuses (Sinus)
Four pairs of air pockets lined with membranes in the bones around the nose. The ethmoid sinuses are located on each side of the nose between the eyes; the maxillary sinuses are located in the cheek above the teeth and below the eyes; the sphenoid sinuses are located deeply behind the eyes; the frontal sinuses are located in the forehead.
Spinal Tap (Lumbar Puncture)
Despite the discomfort felt by many over this procedure, spinal taps are actually very simple procedures from the doctor's standpoint. Because the fluid that coats and flows through the brain also flows down into the spinal cord, the spinal fluid reflects what is occurring in the brain. A spinal tap involves: numbing the skin over the lower part of the spine with an injection or cream; sterilizing the area; having the patient curl up on his side while being held securely; passing a needle through the skin at a large space in between two of the lower vertebrae (the needle does NOT pass through bone); slowly advancing the needle until it "pops" through the lining of the spinal canal into an area of spinal fluid (the needle does NOT go into the spinal cord where the nerves are because the spinal cord stops further up the spine: the bottom of the spine simply contains a reservoir of spinal fluid); spinal fluid will flow out through the needle and the doctor will collect it and send it to the lab. Once the needle is pulled out, the hole seals up rapidly.
Staphylococcus (Staph, Staphylococcal)
A genus of micrococci bacteria with many members that can cause disease. They are gram-positive, nonmotile bacteria
that are aerobic-(unless they need to be anaerobic). Staph of various types are responsible for boils and carbuncles; they may be involved in impetigo, toxic shock syndrome, endocarditis, osteomyelitis, and urinary tract infections, as well as some food poisoning. They stay around hospitals and veterinary clinics waiting to get you. They are also a normal part of the mouth, throat, and skin flora in a third to a half of all of us, causing no problems, but just waiting. Staph has always been with us. Some even eat our antibiotics for breakfast.
Streptococcus (Strep)
A genus of gram-staining chain-forming cocci bacteria. Some are responsible for common and potentially serious human infections, ranging from scarlet fever and strep throat to bacterial endocarditis and pus pockets. Most of the disease-potential streps are also a normal part of the skin, mouth and upper respiratory flora.
Thrombosis
Formation of blood clots causing vascular obstruction.
Venous
Pertaining to the veins.
X-rays (X-ray)
High-energy radiation used to take pictures of areas inside the body.
Last updated: Sep 28, 2008
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