Differential Diagnosis for Orbital Cellulitis
- Single most likely diagnosis
- Bacterial orbital cellulitis: This is the most common cause of orbital cellulitis, often resulting from an extension of sinusitis or from a direct infection following trauma. The presence of symptoms such as eyelid swelling, proptosis, and limited eye movement, along with fever and leukocytosis, supports this diagnosis.
- Other Likely diagnoses
- Fungal orbital cellulitis: This can occur, especially in immunocompromised patients or those with a history of fungal sinusitis. Symptoms may be similar to bacterial cellulitis but might have a more insidious onset.
- Orbital abscess: An abscess within the orbit can present similarly to cellulitis but may have more pronounced proptosis and limitation of eye movement due to a localized collection of pus.
- Preseptal cellulitis: While this condition affects the eyelid and periorbital tissues anterior to the orbital septum, its presentation can sometimes be confused with orbital cellulitis, especially if there's significant swelling.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cavernous sinus thrombosis: A potentially life-threatening complication of orbital cellulitis, characterized by the formation of a blood clot within the cavernous sinus. Symptoms can include bilateral eye involvement, cranial nerve palsies, and signs of increased intracranial pressure.
- Mucormycosis: A rare but highly aggressive fungal infection that can cause orbital cellulitis, particularly in diabetic or immunocompromised patients. It can lead to rapid tissue destruction and has a high mortality rate if not promptly treated.
- Rare diagnoses
- Orbital tuberculosis: A rare cause of orbital inflammation that can mimic cellulitis. It's more common in areas where tuberculosis is endemic and can present with chronic symptoms.
- Orbital sarcoidosis: This condition can cause uveitis, eyelid swelling, and orbital inflammation, which might be mistaken for cellulitis. It's part of a systemic disease and requires a comprehensive diagnostic approach.
- Wegener's granulomatosis (Granulomatosis with Polyangiitis): A systemic vasculitis that can involve the orbit and sinuses, presenting with symptoms that could be confused with orbital cellulitis, including destructive lesions of the nasal passages and sinuses.