Orbital cellulitis

Orbital cellulitis

Description, Causes and Risk Factors:

The orbital septum is a fibrous sheet that separates eyelids from orbital cavity contents. It is a continuation of the orbit periosteum & extends to the tarsal plates. Orbital cellulitis is uncommon, but potentially life-threatening, characterized by infection of the soft tissues behind the orbital septum. Preseptal (peri-orbital) cellulitis is a much more common and less serious infection anterior to the orbital septum, very occasionally, preseptal.

Orbital cellulitis is an infection of the soft orbital tissue posterior to the orbital septum. This is in contrast to preseptal cellulitis which is a soft tissue infection of the eyelids anterior to the orbital septum.

The most common bacterial organisms in orbital cellulitis include Streptococcus species, Staphylococcus aureus, Pseudomonas, Enterococcus, Klebsiella, Haemophilus influenzae type B, Methicillin-resistant Staphylococcus aureus (MRSA) is becoming more common in orbital cellulitis. If a fungal infection is suspected, consider Mucor and Aspergillus species.

Other causes include a stye on the eyelid, bug bites, or a recent eyelid injury.

Orbital cellulitis infections in children may get worse very quickly and can lead to blindness. Immediate medical attention is needed.


Symptoms may include:

    Fever, generally 102 degrees Fahrenheit ( 38.9 degrees Celcius ) or higher.

  • Painful swelling of upper and lower eyelids.

  • Shiny, red or purple eyelid.

  • Eye pain, especially with movement.

  • Decreased vision.

  • Bulging eyes.

  • General malaise.

  • Painful or difficult eye movements.


If a diagnosis of preseptal cellulitis is entertained, a well-defined event should be elicited from the patient (e.g. injury, stye, bug bite, etc). If a convincing event cannot be elicited, an orbital etiology should always be investigated with orbital imaging. The patient in this case was diagnosed initially with a preseptal cellulitis with no predisposing event.

Tests commonly include:

    CBC (complete blood count).

  • Blood culture.

  • Spinal tap in extremely sick children.

Other tests may include:

    X-ray of the sinuses and surrounding area.

  • CT scan or MRI of the sinuses and orbit.

  • Culture of eye and nose drainage.

  • Throat culture.


The patient usually needs to stay in the hospital. Treatment includes antibiotics given through a vein. Surgery may be needed to drain the abscess. An orbital cellulitis infection can get worse very quickly. The patient must be carefully checked every few hours.

Orbital Cellulitis Treatment and Prevention Tips:

    Corticosteroids may be helpful in this condition.

  • Ocular antihypertensives should be instigated promptly

  • If an Abscess develops, surgical drainage may be needed.

  • Antibiotics such as Nafcillin, Ampicillin, or Cefotaxime may be given intravenously (IV).

Risk and benefits of the drugs must be discussed with your doctor.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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