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  • Orbital Cellulitis

    Definition

    Orbital cellulitis is a serious infection of the bony cavity in which the eyeball sits, which is called the orbit. It is surrounded by sinuses. The sinuses are the hollow areas of the skull around the nose.
    Orbital cellulitis affects not only the eye, but the eyelids, eyebrows, and cheeks. It causes the eyeball to have a swollen appearance. If the infection is not treated, it can lead to blindness.
    Eyeball in Orbit
    Eye bone socket nerve
    The cavity below the eye is a sinus, the most common place for the infection to start.
    Copyright © Nucleus Medical Media, Inc.

    Causes

    There are several common causes of orbital cellulitis:
      Infections that spread from areas around the eye including:
      • Sinuses—this is the most common reason
      • Mouth and teeth
      • Face
    • Infections that spread from the bloodstream
    • Injury or surgery in the area
    • Stye on the eyelid
    • Bug bite or sting to the eyelid
    Children are at high risk of severe infections from orbital cellulitis that could result in blindness. For this reason, they should be given medical attention right away. In young children, the infection is often caused by a sinus infection due to a organism called Haemophilus influenzae .

    Risk Factors

    Factors that increase your risk of getting orbital cellulitis include:

    Symptoms

    Symptoms of orbital cellulitis include:
    • Bulging eye
    • Painful eye movements
    • Tender or warm tissues around the eye
    • Swollen eyelids
    • Difficulty seeing when eyelid is swollen
    • Fever
    • Not feeling well
    • Headache
    • Runny nose
    • Double vision
    • Blurry vision

    Diagnosis

    Doctors can often recognize orbital cellulitis by examining your eyes, teeth, and mouth. Your medical and family history will be taken. You may also have the following tests done:
    Your bodily fluids may be tested. This can be done with:
    • Blood tests
    • Testing samples from the lining of your eye, nose, and throat
    • A spinal tap in very sick children
    Images may be taken of your bodily structures. This can be done with:

    Treatment

    Orbital cellulitis can worsen quickly. Often it requires hospitalization. Treatment for orbital cellulitis includes:
    • Antibiotics are given to treat the infection. They will be started right away, even before results from the laboratory have come back. Antibiotics are generally given by mouth for three weeks. If the infection is serious, antibiotics may be given through an IV for at least several days.
    • Nasal decongestants will help sinus drainage if you have sinusitis.
    • Diuretics or eye drops are given to help decrease pressure within the eyeball.
    • Surgery may be performed to drain a pus collection from an infected sinus or orbit.
    If you are diagnosed with orbital cellulitis, follow your doctor's instructions .

    Prevention

    Treating sinus or dental infections right away may prevent them from spreading to the eyes. In addition, children should be protected with the Hib B vaccine, which will prevent most of the Haemophilus influenzae infections.

    RESOURCES

    National Eye Institute http://www.nei.nih.gov

    Retina International http://www.retina-international.org

    CANADIAN RESOURCES

    Canadian Ophthalmological Society http://www.eyesite.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Distinguishing periorbital from orbital cellulitis. Am Fam Physician. 2003 Mar 15;67(6):1349-1353. American Family Physician website. Available at: http://www.aafp.org/afp/2003/0315/p1349a.html . Accessed March 25, 2013.

    Beers MH, Fletcher AJ, Jones TV, et al, eds. The Merck Manual of Medical Information . 2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003.

    Orbital cellulitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated November 13, 2012. Accessed March 25, 2013.

    Givner LB. Periorbital versus orbital cellulitis. Ped Infect Dis J . 2002; 21:1157-1158.

    Periorbital cellulitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 14, 2010. Accessed March 25, 2013.

    Preseptal and orbital cellulitis. Pediatric Care Online website. Available at: http://www.pediatriccareonline.org/pco/ub/view/Point-of-Care-Quick-Reference/397218/0/Preseptal%5Fand%5FOrbital%5FCellulitis . Updated March 8, 2010. Accessed March 25, 2013.

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