From the Guidelines
Orbital cellulitis is a medical emergency that presents with symptoms such as painful eye swelling, redness of the eyelids and surrounding tissues, limited or painful eye movement, fever, decreased vision, bulging of the eye (proptosis), and inability to fully open the eye, as noted in the most recent study 1.
Symptoms of Orbital Cellulitis
The symptoms of orbital cellulitis can be categorized into several key areas, including:
- Painful eye swelling and redness of the eyelids and surrounding tissues
- Limited or painful eye movement
- Fever
- Decreased vision
- Bulging of the eye (proptosis)
- Inability to fully open the eye
- Double vision, which may occur as the infection affects eye muscle function
- Headache, lethargy, and reduced pupillary response to light in severe cases
Causes and Complications
Orbital cellulitis results from bacterial infection spreading to the tissues surrounding the eye, often originating from sinusitis, trauma, or skin infections, with Staphylococcus and Streptococcus species being common causative organisms 1. Delayed treatment can lead to serious complications, including vision loss, cavernous sinus thrombosis, brain abscess, or meningitis.
Diagnosis and Treatment
The primary role of imaging is to differentiate preseptal cellulitis from postseptal cellulitis and abscess, and to identify underlying sinusitis and intracranial complications of orbital infections 1. Prompt treatment with intravenous antibiotics, such as vancomycin plus ceftriaxone or ampicillin-sulbactam, is essential to prevent serious complications and improve outcomes 1.
From the Research
Symptoms of Orbital Cellulitis
The symptoms of orbital cellulitis include:
- Erythema and edema of the eyelids 2, 3, 4, 5
- Vision loss 2, 3, 6, 5
- Fever 2, 3, 4, 5
- Headache 2, 3, 5
- Proptosis 2, 3, 4, 5
- Chemosis 2, 3, 4, 5
- Diplopia 2, 3, 5
- Blurred vision 3, 6, 5
- Ophthalmoplegia 5
- Diffuse lid edema with or without erythema 5
Causes and Risk Factors
Orbital cellulitis can be caused by:
- Sinus infection 2, 3, 6, 5
- Infection of the eyelids or face 2, 3
- Hematogenous spread from distant locations 2, 3
- Trauma 3, 6, 5
- Retained foreign bodies 3
- Preexisting dental infections 5
- Dental procedures 5
- Maxillofacial surgeries 5
- Open Reduction and Internal Fixation (ORIF) 5
- Retinal buckling procedures 5
Diagnosis and Treatment
Diagnosis of orbital cellulitis can be made using:
- Computed tomography (CT) imaging 2, 6, 5
- Magnetic resonance imaging (MRI) 5 Treatment of orbital cellulitis includes:
- Antibiotic coverage 2, 3, 6, 5
- Surgical intervention when needed 2, 3, 6, 5
- Drainage of pus and establishment of ventilation to the sinus if the infection is secondary to sinus infection 5