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Orbital cellulitis

Definition

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

Causes, incidence, and risk factors

Orbital cellulitis is a dangerous infection with potentially serious complications.

Bacteria from a sinus infection (often Haemophilus influenzae) usually cause this condition in children. Orbital cellulitis due to this bacteria used to be much more common in young children up to age 6 - 7. However, such infection is now rare because of the 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

Symptoms of orbital cellulitis may include:

• Painful swelling of upper and lower eyelid, and possibly the eyebrow and cheek
• Bulging eyes
• Decreased vision
• Eye pain, especially when moving the eye
• Fever, generally 102 degrees F or higher
• General feeling of discomfort
• Painful or difficult eye movements
• Shiny, red or purple eyelid

Signs and tests

Tests commonly include:

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

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

The patient usually needs to stay in the hospital. Treatment includes antibiotics given through a vein. Surgery may be needed to drain the abscess, or relieve pressure in the orbital space around and behind the eye.

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

Support Groups

Expectations (prognosis)

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

Complications

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

Calling your health care provider

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.

References

Wald ER. Periorbital and orbital infections. In: Long SS, ed. Principles and Practice of Pediatric Infectious Diseases. 3rd ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 89.

Olitsky SE, Hug D, Smith LP. Orbital infections. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 633.

Durand ML. Periocular infections. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 114.