Orbital cellulitis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Orbital cellulitis is a serious infection of the orbital tissues which can lead to restriction of eye movements, loss of vision and even loss of life. Orbital cellulitis is an inflammation of eye tissues posterior to the orbital septum. It most commonly refers to an acute spread of infection into the eye socket from either the adjacent sinuses or through the blood. When it affects the rear of the eye, it is known as retro-orbital cellulitis.
It should not be confused with periorbital cellulitis, which refers to cellulitis anterior to the septum.\
Causes
Orbital cellulitis occurs commonly from bacterial infection spread by the paranasal sinuses. Other ways in which orbital cellulitis may occur is from infection in the blood stream and from an eyelid skin infection. Upper respiratory infection, sinusitis, trauma to the eye, ocular or periocular infection and systemic infection all increase one’s risk of orbital cellulitis.Staphylococcus aureus, Streptococcus pneumoniae and beta-hemolytic streptococci are three bacteria that can be responsible for orbital cellulitis.
Differentiating Orbital Cellulitis from other Diseases
Orbital cellulitis should be differentiated from preseptal cellulitis which is confined to structures anterior to orbital septum. Where as, orbital cellulitis involves structures posterior to orbital septum which includes fat and ocular muscles.
Diagnosis
History and Symptoms
Patients present with sudden onset of fever, proptosis, restricted eye movement, and swelling and redness of the eye lids. It is usually caused by a previous sinusitis. Patients commonly complain of pain when moving the eye, sudden loss of vision, bulging of the eye or eyes that are infected and limited eye movement. Along with these symptoms, patients typically have redness and swelling of the eyelid, pain, discharge, inability to open the eye, occasional fever and lethargy. It is usually caused by a previous sinusitis. Other causes include infection of nearby structures, trauma and previous surgery.
Medical Therapy
Because of concern for spread of infection, patients must be admitted to the hospital to receive intravenous antibiotics. Orbital cellulitis is considered an ophthalmological emergency.Prompt treatment is vital for a patient when fighting orbital cellulitis. Treatment typically involves IV antibiotics in the hospital and frequent observation (every 4-6 hours). Along with this several laboratory tests are run including a complete blood count, differential, and blood culture.
Surgery
An abscess can threaten the vision or neurological status of a patient with orbital cellulitis, therefore sometimes surgical intervention is necessary. Surgery typically requires drainage of the sinuses and if a subperiosteal abscess is present in the medial orbit, drainage can be performed endoscopically. Post-operatively, patients must follow up regularly with their surgeon and remain under close observation.