Orbital cellulitis

Orbital cellulitis is a dangerous infection, which can cause lasting problems. Orbital cellulitis is different than periorbital cellulitis, which is an infection of the eyelid or skin around the eye.

In children, it often starts out as a bacterial sinus infection from Haemophilus influenza. The infection used to be more common in young children, under the age of 7. It is now rare due to a vaccine that helps prevent this infection.

The bacteria Staphylococcus aureus, Streptococcus pneumoniae, and beta-hemolytic streptococci may also cause orbital cellulitis.

Orbital cellulitis infections in children may get worse very quickly and can lead to blindness. Medical care is needed right away.

Symptoms may include:

• Painful swelling of upper and lower eyelid, and possibly the eyebrow and cheek
• Bulging eyes
• Decreased vision
• Pain when moving the eye
• Fever, often 102°F (38.8°C) or higher
• General ill feeling
• Difficult eye movements, perhaps with double vision
• Shiny, red or purple eyelid

Tests commonly done include:

• CBC (complete blood count)
• Blood culture
• Spinal tap in affected children who are very sick

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

In most cases, a hospital stay is needed. Treatment most often includes antibiotics given through a vein. Surgery may be needed to drain the abscess, or relieve pressure in the space around the eye.

An orbital cellulitis infection can get worse very quickly. A person with this condition must be checked every few hours.

With prompt treatment, the person can recover fully.

Complications may include:

• Cavernous sinus thrombosis (formation of a blood clot in a cavity at the base of the brain)
• Hearing loss
• Septicemia or blood infection
• Meningitis
• Optic nerve damage and loss of vision

Orbital cellulitis is a medical emergency that needs to be treated right away. Call your health care provider if there are signs of eyelid swelling, especially with a fever.

Getting scheduled HiB vaccine shots will prevent the infection in most children. Young children who share a household with a person who has this infection may need to take antibiotics to avoid getting sick.

Prompt treatment of a sinus or dental infection may prevent it from spreading and becoming orbital cellulitis.

Durand ML. Periocular infections. Bennett JE, Dolin R, Blaser MJ, eds. In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 118.

Olitsky SE, Hug D, Plummer LS, Stahl ED, Ariss MM, Lindquist TP. Orbital infections. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 634.

Wald ER. Periorbital and orbital infections. In: Long SS, ed. Principles and Practice of Pediatric Infectious Diseases. 4th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 87.

Yen MT, Lee S. Microbial preseptal and orbital cellulitis. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 2013 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:vol 4, chap 25.

Updated by: Franklin W. Lusby, MD, ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.