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Orbital cellulitis

Orbital cellulitis is a sudden (acute ) infection of the tissues around the eye. It affects the eyelids, eyebrow, and cheek.

Causes

Orbital cellulitis is a dangerous infection, which can cause lasting problems.

The most common cause of this condition in children is a sinus infection (often Haemophilus influenzae. The infection used to be more common in young children, under the age of 7. It is now rare due to the HiB (Haemophilus influenzae B) vaccine.

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
  • Eye pain , especially when moving the eye
  • Fever, generally 102° F or higher
  • General ill feeling
  • Painful or difficult eye movements
  • Shiny, red or purple eyelid

Exams and Tests

Tests commonly done include:

Other tests may include:

Treatment

In ost 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:

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 to the eyes.

References

Durand ML. Periocular infections. Bennett JE, Dolin R, Blaser MJ, eds. In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2014:chap 118.

Olitsky SE, Hug D, Plummer LS, Stass-Isern M. Orbital infections. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 626.

Wald ER. Periorbital and orbital infections. In: Long SS, ed. Principles and Practice of Pediatric Infectious Diseases. 4th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 87.

Yen MT, Lee S. Microbial Preseptal and Orbital Cellulitis. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 2013 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:vol 4, chap 25.

Updated: 9/2/2014

Franklin W. Lusby, MD, ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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