Orbital Cellulitis
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Orbital Cellulitis

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Definition

Orbital cellulitis is a serious infection of the bony cavity in which the eyeball sits, which is called the orbit. It is surrounded by sinuses. The sinuses are the hollow areas of the skull around the nose.

Orbital cellulitis affects not only the eye, but the eyelids, eyebrows, and cheeks. It causes the eyeball to have a swollen appearance. If the infection is not treated, it can lead to blindness.

Eyeball in Orbit

Eye bone socket nerve

The cavity below the eye is a sinus, the most common place for the infection to start.

© 2008 Nucleus Medical Art, Inc.

Causes

There are several common causes of orbital cellulitis:

  • Infections that spread from areas around the eye including:
    • Sinuses (this is the most common reason)
    • Mouth and teeth
    • Face
  • Infections that spread from the bloodstream
  • Injury or surgery in the area
  • Stye on the eyelid
  • Bug bite or sting to the eyelid

Children are at high risk of severe infections from orbital cellulitis that could result in blindness. For this reason, they should be given immediate medical attention. In young children, the infection is often caused by a sinus infection due to a organism called Haemophilus influenzae .

Risk Factors

A risk factor is something that increases the chance of getting a disease or condition. Some risk factors for orbital cellulitis include:

Symptoms

Symptoms of orbital cellulitis include:

  • Bulging eye
  • Painful eye movements
  • Tender or warm tissues around the eye
  • Swollen eyelids
  • Difficulty seeing when eyelid is swollen
  • Fever
  • Not feeling well
  • Headache
  • Runny nose
  • Double vision
  • Blurry vision

Diagnosis

Doctors can often recognize orbital cellulitis by examining your eyes, teeth, and mouth. However, to determine the cause of the infection, you may be given the following tests or examinations:

  • Medical history, which includes questions about your diet, medications, use of corrective lenses, and family history of diabetes
  • Complete blood count
  • Computed tomography (CT) scan or MRI of your sinuses and orbit
  • X-ray of your sinuses and orbit
  • Samples from the lining of your eye, nose, throat, blood may be sent to the laboratory for testing and culture
  • Spinal tap in very sick children

Treatment

Orbital cellulitis can worsen quickly. Often it requires hospitalization. Treatment for orbital cellulitis includes:

  • Antibiotics are given to treat the infection. They will be started immediately, even before results from the laboratory have come back. Antibiotics are generally given by mouth for three weeks. If the infection is serious, antibiotics may be given through an intravenous drip for at least several days.
  • Nasal decongestants will help sinus drainage if patient has sinusitis.
  • Diuretics or eye drops are given to help decrease pressure within the eyeball.
  • Surgery may be performed to drain a pus collection from an infected sinus or orbit.

Prevention

Treating sinus or dental infections promptly may prevent them from spreading to the eyes. In addition, children should be protected with the Hib B vaccine, which will prevent most of the Haemophilus influenzae infections.

RESOURCES:

American Academy of Family Physicians
www.familydoctor.org

National Eye Institute: US National Institutes of Health
www.nei.nih.gov

Retina International
www.retina-international.org

CANADIAN RESOURCES:

Canadian Ophthalmological Society
http://www.eyesite.ca

University of Ottawa Eye Institute
http://www.eyeinstitute.net/main.html

References:

Beers, MH, Fletcher AJ, Jones TV, et al, eds. The Merck Manual of Medical Information . Second Home Edition. Whitehouse Station, NJ: Merck Research Laboratories; 2003.

Distinguishing periorbital from orbital cellulitis. American Family Physician website. Available at: http://www.aafp.org/afp/20030315/tips/23.html . Accessed August 20, 2005.

Givner LB. Periorbital versus orbital cellulitis. Ped Infect Dis J . 2002; 21:1157-8.

Harrington JN. Orbital cellulitis (November 3, 2006). eMedicine website. Available at: http://www.emedicine.com .

Orbital cellulitis. Dynamed website. Available at http://dynamedical.com/dynamed.nsf?opendatabase . Accessed August 19, 2005.

Vision–orbital cellulitis. Medline Plus (National Library of Medicine and the National Institutes of Health) website. Available at http://www.nlm.nih.gov/medlineplus/ency/article/001012.htm . Accessed on August 21, 2005.



Last reviewed January 2008 by Christopher Cheyer, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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