Orbital cellulitis affects the eye socket (orbit) as well as the skin closest to it. It is more common in children than it is in adults. Symptoms of periorbital cellulitis include fever, redness, and swelling of the eyelid. Periorbital cellulitis happens when infection-causing bacteria (like staphylococcus or streptococcus) is introduced into the eyelid by a scratch, a bug bite, a sty, or a chalazion. Periorbital cellulitis is an inflammation and infection of the eyelid and the skin surrounding the eye.
Orbital cellulitis is postseptal and involves the orbit itself. The most common cause is extension of infection from sinusitis, although penetrating trauma causes some cases. The orbit is surrounded by the sinuses. The ethmoid sinus is the most common source of orbital infection because a very thin septum separates it from the orbit. Generally, orbital cellulitis occurs in older children because sinusitis is more common as children reach the preteen years. Orbital cellulitis can cause bacteremia.
Causes
Orbital cellulitis is a dangerous infection with potentially serious complications.
Bacteria from a sinus infection (often Haemophilus influenzae) usually cause this condition in children. Children up to age 6 - 7 seem to be particularly susceptible to infection with this type of bacteria. However, the rate of severe orbital cellulitis has dropped steadily since the introduction of HiB (Haemophilus influenzae B) vaccine.The bacteria Staphylococcus aureus, Streptococcus pneumoniae, and beta-hemolytic streptococci may also cause orbital cellulitis.
Infants and children up through age 6 - 7 years seem to be particularly susceptible to infection with Hemophilus influenzae, and are most at risk. The incidence of severe disease has decreased steadily since the introduction of HiB vaccine (Hemophilus influenzae B). Risk factors include sinus infections or injury to the eyelid, including bug bites. Although the infection usually rapidly improves with antibiotic treatment, hospitalization may be required.
Signs and Symptoms
Symptoms and signs of orbital cellulitis include swelling and redness of the eyelid and surrounding soft tissues, conjunctival hyperemia and chemosis, decreased ocular motility, pain with eye movements, decreased visual acuity, and exophthalmos caused by orbital swelling. Signs of the primary infection are also often present (eg, nasal discharge and bleeding with sinusitis, periodontal pain and swelling with abscess). Fever, malaise, and headache should raise suspicion of associated meningitis. Some or all of these findings may be absent early in the course of the infection.
The characteristic symptoms of orbital cellulitis are eye pain, redness, swelling, warmth, and tenderness. The eye may bulge out and it may be difficult or impossible to move. Temporary loss of vision, pus drainage from the eye, chills, fever, headaches, vomiting, and a general ill feeling may occur.
Diagnosis
An eye doctor may use special instruments to open a swollen lid in order to:
?examine the position of the eyeball
?evaluate eye movement
?test the patient's vision.
Treatment
Hospitalization is always required. Treatment consists of IV fluids with antibiotics. Surgical drainage of an abscess may be necessary. Proper evaluation and early treatment of sinus, dental, or other infections may prevent the spread of infection to the eye(s).
