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Orbital cellulitis

 

Orbital cellulitis is an infection of the fat and muscles around the eye. It affects the eyelids, eyebrows, and cheeks. It may begin suddenly or be a result of an infection that gradually becomes worse.

Causes

Orbital cellulitis is a dangerous infection, which can cause lasting problems. Orbital cellulitis is different than periorbital cellulitis, which is an infection of the eyelid or skin around the eye.

In children, it often starts out as a bacterial sinus infection from Haemophilus influenza. The infection used to be more common in young children, under the age of 7. It is now rare due to a vaccine that helps prevent this infection.

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

Orbital cellulitis infections in children may get worse very quickly and can lead to blindness. Medical care is needed right away.

Symptoms

 

Symptoms may include:

  • Painful swelling of upper and lower eyelid, and possibly the eyebrow and cheek
  • Bulging eyes
  • Decreased vision
  • Pain when moving the eye
  • Fever, often 102°F (38.8°C) or higher
  • General ill feeling
  • Difficult eye movements, perhaps with double vision
  • Shiny, red or purple eyelid

 

Exams and Tests

 

Tests commonly done include:

  • CBC (complete blood count)
  • Blood culture
  • Spinal tap in affected children who are very sick

Other tests may include:

  • 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

 

In most cases, a hospital stay is needed. Treatment most often includes antibiotics given through a vein. Surgery may be needed to drain the abscess or relieve pressure in the space around the eye.

An orbital cellulitis infection can get worse very quickly. A person with this condition must be checked every few hours.

 

Outlook (Prognosis)

 

With prompt treatment, the person can recover fully.

 

Possible Complications

 

Complications may include:

  • Cavernous sinus thrombosis (formation of a blood clot in a cavity at the base of the brain)
  • Hearing loss
  • Septicemia or blood infection
  • Meningitis
  • Optic nerve damage and loss of vision

 

When to Contact a Medical Professional

 

Orbital cellulitis is a medical emergency that needs to be treated right away. Call your health care provider if there are signs of eyelid swelling, especially with a fever.

 

Prevention

 

Getting scheduled HiB vaccine shots will prevent the infection in most children. Young children who share a household with a person who has this infection may need to take antibiotics to avoid getting sick.

Prompt treatment of a sinus or dental infection may prevent it from spreading and becoming orbital cellulitis.

 

 

References

Bhatt A. Ocular infections. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 61.

Durand ML. Periocular infections. Bennett JE, Dolin R, Blaser MJ, eds. In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 118.

McNab AA. Orbital infection and inflammation. In: Yanoff M, Duker JS, eds. Ophthalmology. 5th ed. Philadelphia, PA: Elsevier; 2019:chap 12.14.

Olitsky SE, Hug D, Plummer LS, Stahl ED, Ariss MM, Lindquist TP. Orbital infections. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 634.

Text only

 
  • Eye anatomy

    Eye anatomy - illustration

    The cornea is the clear layer covering the front of the eye. The cornea works with the lens of the eye to focus images on the retina.

    Eye anatomy

    illustration

  • Haemophilus influenza organism

    Haemophilus influenza organism - illustration

    This picture shows the organism Haemophilus influenza. Infections caused by Haemophilus influenza usually occur in children under 6 years old and are extremely serious. Haemophilus (type B) is responsible for meningitis, periorbital cellulitis, buccal cellulitis and epiglottitis, septic arthritis, osteomyelitis, pericarditis, and bacteremia. The small organisms live within cells (intracellular) as shown in this picture. (Image courtesy of the Centers for Disease Control and Prevention.)

    Haemophilus influenza organism

    illustration

    • Eye anatomy

      Eye anatomy - illustration

      The cornea is the clear layer covering the front of the eye. The cornea works with the lens of the eye to focus images on the retina.

      Eye anatomy

      illustration

    • Haemophilus influenza organism

      Haemophilus influenza organism - illustration

      This picture shows the organism Haemophilus influenza. Infections caused by Haemophilus influenza usually occur in children under 6 years old and are extremely serious. Haemophilus (type B) is responsible for meningitis, periorbital cellulitis, buccal cellulitis and epiglottitis, septic arthritis, osteomyelitis, pericarditis, and bacteremia. The small organisms live within cells (intracellular) as shown in this picture. (Image courtesy of the Centers for Disease Control and Prevention.)

      Haemophilus influenza organism

      illustration

    A Closer Look

     

      Tests for Orbital cellulitis

       
         

        Review Date: 9/22/2018

        Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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