From the Guidelines
Orbital cellulitis is characterized by clinical signs including proptosis, impaired visual acuity, and impaired extraocular mobility, which are indicative of postseptal inflammation and require immediate medical attention. Patients typically develop painful eye swelling, redness, and warmth around the affected eye, often with significant eyelid edema that may make it difficult to open the eye. According to 1, proptosis and limitation of the extraocular movements are indicators of postseptal inflammation. Other clinical findings may include conjunctival chemosis (swelling) and injection (redness), vision impairment, diplopia (double vision), and systemic symptoms such as fever, malaise, and headache. In severe cases, patients may develop ophthalmoplegia (paralysis of eye muscles), decreased visual acuity, afferent pupillary defect, or signs of increased intraocular pressure.
The condition typically develops rapidly, often following sinusitis, trauma, or upper respiratory infection, as noted in 1. Orbital cellulitis requires immediate medical attention as it can lead to serious complications including vision loss, cavernous sinus thrombosis, meningitis, or brain abscess if left untreated. The inflammation involves tissues posterior to the orbital septum, distinguishing it from the less severe preseptal cellulitis. Key clinical signs that distinguish postseptal cellulitis from preseptal cellulitis include proptosis, impaired visual acuity, and impaired extraocular mobility, which are critical for early diagnosis and treatment, as emphasized in 1.
Some key points to consider in the diagnosis of orbital cellulitis include:
- Clinical findings alone may not be specific enough to distinguish preseptal from orbital infections or those with complications, as noted in 1
- Imaging plays a crucial role in differentiating preseptal cellulitis from postseptal cellulitis and abscess, and in identifying underlying sinusitis and intracranial complications of orbital infections, as stated in 1
- The primary role of imaging is to confirm the diagnosis and guide treatment, as emphasized in 1
- Appropriate antimicrobial therapy for intraorbital complications includes vancomycin, as recommended in 1, and should be tailored to the results of culture and sensitivity studies when they become available.
Overall, the clinical signs of orbital cellulitis, including proptosis, impaired visual acuity, and impaired extraocular mobility, are critical for early diagnosis and treatment, and require immediate medical attention to prevent serious complications.
From the Research
Clinical Signs of Orbital Cellulitis
The clinical signs of orbital cellulitis include:
- Erythema and edema of the eyelids 2, 3, 4, 5
- Vision loss 2, 4, 5
- Fever 2, 6, 4
- Headache 2
- Proptosis 2, 3, 4, 5
- Chemosis 2, 3, 4, 5
- Diplopia 2
- Restriction of eye movement 4
- Congestion and eyelid swelling 4
- Ophthalmoplegia 5
Forms of Orbital Cellulitis
Orbital cellulitis can be divided into two forms:
- Preseptal form, anterior to the orbital septum 3
- Retroseptal form, posterior to the orbital septum, also known as "true" orbital cellulitis 3
Complications of Orbital Cellulitis
If left untreated, orbital cellulitis can lead to serious complications, including: