Orbital cellulitis

Definition

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:

Other tests may include:

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:

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.

Images

Eye anatomy
Haemophilus influenza organism

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.

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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