Orbital Cellulitis

Orbital cellulitis is a serious infection of the fat and muscles behind the eye (in the orbit). It's a medical emergency that requires prompt treatment with IV antibiotics and sometimes surgery to prevent permanent vision loss and potentially life-threatening spread of infection.

Orbital vs. Preseptal Cellulitis

It's important to distinguish orbital cellulitis from the less serious preseptal (periorbital) cellulitis:

Preseptal Cellulitis

• Infection in front of the orbital septum
• Eyelid swelling and redness
• Eye movement normal
• Vision normal
• No proptosis
• Less urgent (but still needs treatment)

Orbital Cellulitis

• Infection behind the orbital septum
• Proptosis (bulging eye)
• Painful eye movement
• Limited eye movement
• May have vision changes
• Medical emergency

Causes

Most Common: Sinus Disease

• Spreads from adjacent sinusitis
• Ethmoid sinusitis most common in children
• Frontal sinusitis in older children/adults

Other Causes

• Spread from preseptal cellulitis
• Dental infections
• Trauma (including surgery)
• Foreign bodies
• Blood-borne spread (rare)

Common Organisms

• Streptococcus species
• Staphylococcus aureus
• Haemophilus influenzae (less common since vaccination)
• Anaerobes
• Polymicrobial infections common

Symptoms

• Eye pain—especially with movement
• Bulging eye (proptosis)
• Eyelid swelling and redness
• Limited eye movement (double vision)
• Fever
• Vision changes (serious sign)
• Headache
• Nasal congestion or discharge

Warning Signs

Diagnosis

Clinical Examination

• Complete eye exam including vision
• Assessment of eye movements
• Pupil examination
• Proptosis measurement
• Examination of sinuses

Imaging

• CT scan of orbits and sinuses
  • Shows extent of infection
  • Identifies abscess if present
  • Evaluates sinus disease
• MRI if intracranial extension suspected

Laboratory Tests

• Complete blood count
• Blood cultures
• Cultures from any drainage

Treatment

Hospitalization

• Most patients require hospital admission
• Close monitoring of vision and eye movement

IV Antibiotics

• Broad-spectrum coverage initially
• Adjusted based on culture results
• Typical regimens include:
  • Vancomycin + ceftriaxone/cefotaxime
  • Or ampicillin-sulbactam
• Duration: typically 2-3 weeks total

Surgical Intervention

Surgery may be needed for:

• Orbital abscess (subperiosteal or orbital)
• No improvement on IV antibiotics (24-48 hours)
• Vision deterioration
• Large abscess on imaging

Surgical options:

• Abscess drainage
• Sinus surgery (to address source)

Supportive Care

• Pain management
• Nasal decongestants
• Elevation of head

Complications

Orbital Complications

• Vision loss (from optic nerve compression)
• Elevated eye pressure
• Corneal exposure
• Chronic motility problems

Intracranial Complications

• Cavernous sinus thrombosis
• Meningitis
• Brain abscess
• These are life-threatening

Prognosis

With prompt treatment:

• Most patients recover fully
• Vision loss is preventable if treated early
• Complications more common with:
  • Delayed treatment
  • Abscess formation
  • Intracranial extension

Prevention

• Prompt treatment of sinus infections
• Good dental hygiene
• Appropriate wound care after facial trauma
• Vaccination (Haemophilus influenzae type b)

Frequently Asked Questions

How quickly does orbital cellulitis develop?

It can develop rapidly, over 24-48 hours. Preseptal cellulitis can progress to orbital cellulitis, and orbital cellulitis can develop serious complications within days if untreated.

Can adults get orbital cellulitis?

Yes, though it's more common in children. In adults, it's often associated with sinus disease, trauma, or dental infections.

How long is the recovery?

With appropriate treatment, improvement usually begins within 24-48 hours. Complete recovery may take several weeks. Some patients need 2-3 weeks of antibiotics.

Will I need surgery?

Not everyone needs surgery. About 25-30% of patients may require surgical drainage, particularly if an abscess has formed or there's no improvement with antibiotics alone.