Orbital cellulitis

Commonly results from bacterial infection, most often as an extension of ethmoid or frontal sinusitis.

Orbital cellulitis is inflammation of eye tissues behind the orbital septum. 



Orbital cellulitis is commonly caused by an acute spread of infection into the eye socket from either the adjacent sinuses or through the blood. 


Orbital cellulitis may occur are from bacteremia or from eyelid skin infections,, upper respiratory infection, sinus infection, trauma to the eye, ocular or periocular infection, and systemic infection.


Most cases arise from a bacterial infection of the sinus, and less commonly include overlying skin infections or hematogenous spread of infection from a distance site. 


It may also occur after trauma. 

May be a result from cutaneous trauma, dental abscess, or dacrocystitis.

When cellitis affects the rear of the eye, it is known as retro-orbital cellulitis.



Orbital cellulitis may lead to serious consequences, including permanent loss of vision or even death.



Can manifest as diffuse cellulitis or focal abscess.

Most common organisms associated or streptococcal and staphylococcal species.

Staphylococcus aureus is one of the primary causes of orbital cellulitis.

Haemophilus influenzae B, Moraxella catarrhalis, Streptococcus pneumoniae, and beta-hemolytic streptococci are bacteria that can be responsible for orbital cellulitis.


Streptococcus pneumoniae is also a gram-positive bacterium responsible for orbital cellulitis due to its ability to infect the sinuses and surrounding tissues.



Orbital cellulitis commonly is from bacterial infection spread via the paranasal sinuses, usually from a previous sinus infection.

Mycobacterium tuberculosis, or atypical mycobacterium can cause orbital imfection.

Inflammatory disease of the orbit can be due to idiopathic disease, IgG4 related disease, sarcoidosis, granulomatosos with polyangitis and histiocyte disorders.

Risk factors for the development of orbital cellulitis include:



Recent upper respiratory illness



Sinus infection



Young age



Retained foreign bodies within the orbit









Systemic infection



Dental infection

The signs of orbital cellulitis are most commonly due to infection: painful eye movement, sudden vision loss, chemosis, bulging of the infected eye, and limited eye movement, redness and swelling of the eyelid, pain, discharge, inability to open the eye, occasional fever and lethargy.

Complications of orbital cellulitis include: hearing loss, bacteremia, meningitis, cavernous sinus thrombosis, cerebral abscess, and blindness.


Children may experience more severe complications due to their immature immune system and of their thinner orbital bones, allowing the infection to spread.


Early diagnosis is emergent, and it involves a complete and thorough physical examination of the eye, and history.


CT scan and MRI imaging aid in the diagnosis and monitoring of orbital cellulitis.

CT scan and MRI imaging can show the extent of inflammation along with possible abscess location, size, and involvement of surrounding structures.

Ultrasound does not cannot provide the same level of detail as CT or MRI.


Differential Diagnosis of orbital cellulitis:

Inflammatory causes of thyroid eye disease, idiopathic orbital inflammatory syndrome, sarcoidosis, granulomatosis with polyangiitis


Infectious causes as a subperiosteal abscess: 

Neoplastic, benign and malignant causes: dermoid cyst, capillary hemangioma, rhabdomyosarcoma, optic nerve glioma, lymphangioma, neurofibroma, leukemia.


Infectious causes as a subperiosteal abscess: 

Neoplastic, benign and malignant causes: dermoid cyst, capillary hemangioma, rhabdomyosarcoma, optic nerve glioma, lymphangioma, neurofibroma, leukemia.


Emergent  treatment involves intravenous (IV) antibiotics: 

Staphylococcus and Streptococcus organisms are the primary targets so penicillins and cephalosporins are typically the best choices for IV antibiotics. 

There is an increasing rise of methicillin-resistant Staphylococcus aureus, and orbital cellulitis can also be treated with Vancomycin, Clindamycin, or Doxycycline. 

The presence of an abscess can threaten the vision or neurological status of a patient with orbital cellulitis, and may require surgical drainage.

Orbital cellulitis is considered an ophthalmic emergency.

It requires prompt medical treatment to achieve a good prognosis.

Bacterial infections of the orbit have a risk of devastating outcomes and intracranial spread: in pre-antibiotic era, death in 17% of patients and permanent blindness in 20%.

Reported rates being much higher among the pediatric population compared to the adult population: children are approximately 16 times more likely to suffer from orbital cellulitis compared to adults.

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