Orbital Cellulitis

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 and Development

Infants and children up to the age of seven seem to be particularly susceptible to infection with Haemophilus 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 paranasal 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 Haemophilus influenzae.  Other organisms such as Staphylococcus aureus, Streptococcus pneumoniae and Beta hemolytic streptococci also may cause this condition.

Signs and 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 and Tests

Tests commonly include:

• Complete blood count
• Blood culture and sensitivity
• 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.

Treatment and 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:

• Cavernous venous sinus thrombosis
• Hearing loss
• Septicemia
• Meningitis
• Optic nerve damage and loss of vision.

A physician should be called if a child exhibits any swelling of the eyelid, especially if it is associated with fever.