orbital cellulitis

Etiology

• associated conditions
  • sinusitis
  • dental infection

Pathology

• inflammation of structures of the orbit, including extraocular muscles & orbital fat
• bacterial infection that involves the soft tissue posterior the orbital septum

Clinical manifestations

• swelling & erythema of the eyelids & conjunctiva (chemosis)
• unilateral proptosis may be present
• ophthalmoplegia: restriction of eye movements
• afferent pupillary defect
• eye pain
  • pain with eye movement
• visual impairment when severe
• fever

Laboratory

• complete blood count (CBC) may show leukocytosis
• Gram stain
• culture both aerobic & anaerobic media
• collect purulent material from the nose with a cotton or calcium alginate swab
• fine needle aspiration of the orbit is contraindicated

Radiology

• CT scan or MRI of the sinuses & orbit

Complications

• cavernous sinus thrombosis
• hearing loss
• septicemia
• meningitis
• optic nerve damage & loss of vision

Differential diagnosis

• optic neuritis
  • loss of color vision affected more severely than visual acuity
  • no fever or chemosis
• acute angle-closure glaucoma
• periorbital cellulitis
  • lacks pain with eye movement, ophthalmoplegia, proptosis, & visual impairment

Management

• admit to hospital
  • fever, leukocytosis
  • failure of oral antibiotics
  • immunosuppression
• intravenous antibiotics targeting likely organisms
  • Streptococcus
  • Staphylococcus
• immediate referral to or consultation with ophthalmologist

More general terms

• orbital inflammation
• eye infection (ocular infection)
• cellulitis