Orbital cellulitis

Definition

Orbital cellulitis is an acute infection of the tissues immediately surrounding the eye, including the eyelids, eyebrow, and cheek.

Causes

Orbital cellulitis is a dangerous infection with potentially serious complications.

Bacteria from a sinus infection (often Haemophilus influenzae) usually cause this condition in children. Children up to age 6 - 7 seem to be particularly susceptible to infection with this type of bacteria. However, the rate of severe orbital cellulitis has dropped steadily since the introduction of HiB (Haemophilus influenzae B) vaccine.

The bacteria Staphylococcus aureus, Streptococcus pneumoniae, and beta-hemolytic streptococci may also cause orbital cellulitis.

Other causes include a stye on the eyelid, bug bites, or a recent eyelid injury.

Orbital cellulitis infections in children may get worse very quickly and can lead to blindness. Immediate medical attention is needed.

Symptoms

• Fever, generally 102 degrees F or higher
• Painful swelling of upper and lower eyelids
• Shiny, red or purple eyelid
• Eye pain, especially with movement
• Decreased vision
• Bulging eyes
• General malaise
• Painful or difficult eye movements

Exams and Tests

Tests commonly include:

• CBC (complete blood count)
• Blood culture
• Spinal tap in extremely sick children

• X-ray of the sinuses and surrounding area
• CT scan or MRI of the sinuses and orbit
• Culture of eye and nose drainage
• Throat culture

Treatment

The patient usually needs to stay in the hospital. Treatment includes antibiotics given through a vein. Surgery may be needed to drain the abscess.

An orbital cellulitis infection can get worse very quickly. The patient must be carefully checked every few hours.

Outlook (Prognosis)

With prompt treatment, the person can make a complete recovery.

Possible Complications

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

When to Contact a Medical Professional

Orbital cellulitis is an emergency that requires immediate treatment. Call your health care provider if there are signs of eyelid swelling, especially with a fever.

Prevention

Receiving the HiB vaccine according to recommended schedules generally will prevent most haemophilus infections in children. Young children in the same household who have been exposed to this bacteria may receive antibiotics to prevent getting sick.

Proper detection and early treatment of sinus, dental, or other infections may prevent the spread of infection to the eyes.

Nageswaran S, Woods CR, Benjamin DK Jr, Givner LB, Shetty AK. Orbital cellulitis in children. Pediatr Infect Dis J. 2006 Aug;25(8):695-9.

Ambati BK, Ambati J, Azar N, Stratton L, Schmidt EV. Periorbital and orbital cellulitis before and after the advent of Haemophilus influenzae type B vaccination. Ophthalmology. 2000 Aug;107(8):1450-3.

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