Orbital cellulitis, which is sometimes called postseptal cellulitis, can occur at any age, but it most commonly affects young children. The infection develops behind the orbital septum, a thin membrane that covers the front of the eyeball.
Periorbital, or preseptal, cellulitis refers to infections that occur in front of the orbital septum. Periorbital cellulitis can spread to the skin around the eye and the eyelid. This condition is less serious than orbital cellulitis but still requires immediate treatment.
In this article, we discuss the symptoms and causes of orbital cellulitis. We also cover the diagnosis, treatment, and complications of this condition.
Orbital cellulitis is a serious infection that affects the fat and muscle tissues within the eye socket, or orbit.
The infection causes inflammation that can push the eye out of the socket. Pain, swelling, and proptosis, which is the protrusion or forward displacement of the eye, are common symptoms of orbital cellulitis.
Other symptoms of orbital cellulitis can include:
- limited eye movement or pain when trying to move the eye
- impaired vision or sudden vision loss
- a red, swollen eyelid
- finding it difficult or impossible to open the eye
- discharge from the infected eye
- loss of appetite
- a headache
Image credit: CDC/ Dr. Thomas F. Sellers/ Emory University, 1964.
Image credit: James Heilman, MD, 2011.
Image credit: Jonathan Trobe, M.D. University of Michigan Kellogg Eye Center, 2011.
Without treatment, sinus infections can spread to the fat and muscle surrounding the eye socket. Bacteria such as the Staphylococcus aureus and Streptococci species are the most common cause of orbital cellulitis.
Minor infections of the eyelid can also spread to the back of the eye, causing orbital cellulitis. Less commonly, bacterial infections in other parts of the body can travel through the bloodstream into the eye socket.
Other, less common causes of orbital cellulitis include:
- an injury to the eye that penetrates the orbital septum
- complications of eye surgery
- abscesses in the mouth
- a foreign object becoming trapped in the eye
A doctor will perform a physical examination to diagnose orbital cellulitis.
It is vital that anyone with symptoms of orbital cellulitis sees a healthcare professional immediately. Early diagnosis of orbital cellulitis is crucial for preventing severe complications.
The diagnosis of orbital cellulitis begins with a physical examination of the person's eye. An ophthalmologist, a doctor who specializes in the eyes, will usually carry out the exam.
The ophthalmologist will check for physical signs of an infection of the eye socket, such as redness, swelling, pain, and fever. They may then order other tests to help determine the extent of the infection and the appropriate course of treatment.
An ophthalmologist or another healthcare professional may take a sample of the person's blood or the discharge from their eye. They will then analyze these samples to determine what kind of germ is causing the infection.
The ophthalmologist may also recommend imaging tests, such as an MRI or CT scan, which create images of the inside of a person's head. These tests allow a healthcare professional to evaluate how far the infection has spread and to check for complications involving the brain or central nervous system.
Orbital cellulitis infections can spread quickly and cause serious complications, so immediate treatment is essential.
The standard treatment options for orbital cellulitis are antibiotics and surgery.
After diagnosing orbital cellulitis, a healthcare professional is likely to recommend immediate treatment with antibiotics. They usually administer these antibiotics continuously through an intravenous line.
Healthcare professionals typically use broad-spectrum antibiotics to treat people with orbital cellulitis. These drugs are effective against a wide range of bacteria, including both Staphylococcus and Streptococcus bacteria.
People with orbital cellulitis usually need to remain in the healthcare facility while they receive antibiotic treatment. Orbital cellulitis can spread quickly, so a healthcare professional will need to monitor the person closely for any signs that the infection is worsening or not responding to the antibiotics.
A doctor can explain the benefits of different treatment options.
Surgical treatment may be necessary if the infection does not respond to antibiotics or spreads to other parts of the head.
People with orbital cellulitis may also require surgery if they:
- experience worsening symptoms or vision impairment while taking antibiotics
- have developed an abscess in the eye socket or the brain
- have a foreign object trapped in the eye
- have a fungal or mycobacterial infection
Surgical procedures for treating orbital cellulitis include:
- draining fluid from an infected area or abscess
- removing a foreign object
- obtaining a culture sample for further analysis
Early diagnosis and treatment of orbital cellulitis are vital to prevent serious complications.
Possible complications of orbital cellulitis include:
- vision loss
- hearing loss
- blood infection, or sepsis
- meningitis, which is an inflammation of the membranes lining the brain and spinal cord
- cavernous sinus thrombosis, which is the formation of a blood clot at the base of the brain
- intracranial abscess, which is an accumulation of pus inside the skull
Young children may experience more severe symptoms, and they have a higher risk of complications because their immune system is still developing.
Orbital cellulitis is a serious infection that causes inflammation of the soft tissue behind the eye. It can cause pain, swelling, and protrusion of the eyeball.
Orbital cellulitis most commonly occurs when bacteria from a sinus infection spread to the eye. People of all ages can develop this condition, but it primarily affects young children.
Without treatment, orbital cellulitis can lead to severe and potentially life-threatening health complications, such as sepsis and meningitis, as well as vision loss. It is crucial that people with symptoms of orbital cellulitis seek immediate medical attention.
Doctors usually treat orbital cellulitis with intravenous antibiotics, but some people may also require surgery.