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Orbital cellulitis

AI overview

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

Key points
  • Most commonly caused by acute spread of infection from adjacent sinuses or through the blood
    source quote
    It is most commonly caused by an acute spread of infection into the eye socket from either the adjacent sinuses or through the blood.
  • May also occur after trauma
    source quote
    It may also occur after trauma.
  • Children may experience more severe complications due to immature immune system and thinner orbital bones
    source quote
    It is possible that children experience more severe complications due to their immature immune system and because they have thinner orbital bones, which makes the infection easier to spread.
  • Children are approximately 16 times more likely to suffer from orbital cellulitis compared to adults
    source quote
    One study reported that children are approximately 16 times more likely to suffer from orbital cellulitis compared to adults.
  • Twice as common among male children compared to female children
    source quote
    It is twice as common among male children compared to female children.
Symptoms
  • Painful eye movement
    source quote
    Orbital cellulitis commonly presents with painful eye movement
  • Sudden vision loss
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    sudden vision loss
  • Chemosis
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    chemosis
  • Bulging of the infected eye
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    bulging of the infected eye
  • Limited eye movement
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    limited eye movement
  • Redness and swelling of the eyelid, pain, discharge, inability to open the eye, occasional fever and lethargy
    source quote
    patients typically have redness and swelling of the eyelid , pain, discharge, inability to open the eye, occasional fever and lethargy
Diagnosis
  • Early diagnosis is urgent and involves a complete and thorough physical examination
    source quote
    Early diagnosis of orbital cellulitis is urgent, and it involves a complete and thorough physical examination.
  • Common presenting signs include proptosis, eyelid edema, eye pain, vision loss, ophthalmoplegia, and fever
    source quote
    Common presenting signs include: a protruding eye ( proptosis ), eyelid edema (swelling), eye pain, vision loss, inability to move the eye completely ( ophthalmoplegia ), and fever.
  • CT scan and MRI are commonly used imaging modalities to aid diagnosis and monitoring
    source quote
    CT scan and MRI of the orbits are two imaging modalities that are commonly used to aid in the diagnosis and monitoring of orbital cellulitis
  • Ultrasound has been used but cannot provide the same level of detail as CT or MRI
    source quote
    Ultrasound has also been used as an imaging modality in the past, but it cannot provide the same level of detail as CT or MRI.
  • Blood cultures, electrolytes, and CBC with differential showing elevated white blood cell count aid in diagnosis
    source quote
    Blood cultures , electrolytes, and a complete blood count (CBC) with differential showing elevated white blood cell count is a useful laboratory test that may aid in diagnosis.
Treatment
  • Immediate treatment involves IV antibiotics in the hospital and frequent observation every 4-6 hours
    source quote
    Immediate treatment is very important, and it typically involves intravenous (IV) antibiotics in the hospital and frequent observation (every 4–6 hours).
  • Penicillins and cephalosporins are typically best choices for IV antibiotics
    source quote
    both penicillins and cephalosporins are typically the best choices for IV antibiotics
  • Due to MRSA rise, Vancomycin, Clindamycin, or Doxycycline can also be used
    source quote
    due to the increasing rise of MRSA (methicillin-resistant Staphylococcus aureus ) orbital cellulitis can also be treated with Vancomycin , Clindamycin , or Doxycycline
  • If improvement after 48 hours of IV antibiotics, can switch to oral antibiotics for 2-3 weeks
    source quote
    If improvement is noted after 48 hours of IV antibiotics, healthcare professionals can then consider switching a patient to oral antibiotics (which must be used for 2–3 weeks).
  • Surgical intervention may be necessary when an abscess threatens vision or neurological status
    source quote
    An abscess can threaten the vision or neurological status of a patient with orbital cellulitis, therefore sometimes surgical intervention is necessary.
  • Surgery typically requires drainage of sinuses; medial orbit subperiosteal abscess can be drained endoscopically
    source quote
    Surgery typically requires drainage of the sinuses and if a subperiosteal abscess is present in the medial orbit, drainage can be performed endoscopically.
  • There is inadequate evidence to draw judgments about the use of steroids in treatment
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    There is inadequate evidence to draw judgments about the use of steroids in the treatment of orbital cellulitis.
Red flags
  • Without proper treatment, may lead to permanent loss of vision or death
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    Without proper treatment, orbital cellulitis may lead to serious consequences, including permanent loss of vision or even death.
  • Complications include hearing loss, blood infection, meningitis, cavernous sinus thrombosis, cerebral abscess, and blindness
    source quote
    Complications include hearing loss, blood infection , meningitis , cavernous sinus thrombosis , cerebral abscess , and blindness.
Prognosis

Good if prompt medical treatment is received; without treatment, death in 17% and permanent blindness in 20% (pre-antibiotic era).

AI-synthesized from the Wikipedia article “Orbital cellulitis”. Not medical advice. Verify source →
Orbital cellulitis
Orbital Cellulitis
SpecialtyOphthalmology 

Orbital cellulitis is inflammation of eye tissues behind the orbital septum. It is most commonly caused by an acute spread of infection into the eye socket from either the adjacent sinuses or through the blood. It may also occur after trauma. When it affects the rear of the eye, it is known as retro-orbital cellulitis.

Without proper treatment, orbital cellulitis may lead to serious consequences, including permanent loss of vision or even death.

Orbital cellulitis commonly presents with painful eye movement, sudden vision loss, chemosis, bulging of the infected eye, and limited eye movement. Along with these symptoms, patients typically have redness and swelling of the eyelid, pain, discharge, inability to open the eye, occasional fever and lethargy.[citation needed]

Complications

Complications include hearing loss, blood infection, meningitis, cavernous sinus thrombosis, cerebral abscess, and blindness.[1][2] It is possible that children experience more severe complications due to their immature immune system and because they have thinner orbital bones, which makes the infection easier to spread.[3][4]

Gram-positive stain, possibly showing staphylococcus aureus, which is one of the primary causes of orbital cellulitis.

Orbital cellulitis occurs commonly from bacterial infection spread via the paranasal sinuses, usually from a previous sinus infection. Other ways in which orbital cellulitis may occur are from blood stream infections or from eyelid skin infections. Upper respiratory infection, sinus infection, trauma to the eye, ocular or periocular infection, and systemic infection all increase one's risk of orbital cellulitis.[citation needed]

Staphylococcus aureus, Haemophilus influenzae type b, Moraxella catarrhalis, Streptococcus pneumoniae, and beta-hemolytic streptococci are bacteria that can be responsible for orbital cellulitis.[5][4]

  • Staphylococcus aureus is a gram-positive bacterium, which is the most common cause of staphylococcal infections. Staphylococcus aureus infection can spread from the skin to the orbit. This organism is able to produce toxins which promotes its virulence, leading to the inflammatory response seen in orbital cellulitis. Staphylococcus infections are identified by a cluster arrangement on Gram stain. Staphylococcus aureus forms large yellow colonies when cultured (which is distinct from other Staph infections such as Staphylococcus epidermidis, which forms white colonies).
  • Streptococcus pneumoniae is also a gram-positive bacterium responsible for orbital cellulitis due to its ability to infect the sinuses. Streptococcal bacteria can invade surrounding tissues, causing the inflammatory response seen in orbital cellulitis (similar to Staphylococcus aureus). Streptococcal infections are identified on culture by their formation of pairs or chains. Streptococcus pneumoniae produce green (alpha) hemolysis, or partial reduction of red blood cell hemoglobin.

Risk factors for the development of orbital cellulitis include, but are not limited to:[6][7]

Early diagnosis of orbital cellulitis is urgent, and it involves a complete and thorough physical examination. Common presenting signs include: a protruding eye (proptosis), eyelid edema (swelling), eye pain, vision loss, inability to move the eye completely (ophthalmoplegia), and fever. It is important to correlate physical findings with patient history and reported symptoms.[8]

CT scan and MRI of the orbits are two imaging modalities that are commonly used to aid in the diagnosis and monitoring of orbital cellulitis, as they can provide detailed images that can show the extent of inflammation along with possible abscess location, size, and involvement of surrounding structures.[3] Ultrasound has also been used as an imaging modality in the past, but it cannot provide the same level of detail as CT or MRI.[3]

Blood cultures, electrolytes, and a complete blood count (CBC) with differential showing elevated white blood cell count is a useful laboratory test that may aid in diagnosis.[8][5]

Differential Diagnosis

A variety of pathologies and diseases can present similarly to orbital cellulitis, including:[9]

Immediate treatment is very important, and it typically involves intravenous (IV) antibiotics in the hospital and frequent observation (every 4–6 hours).[2][10] Several lab tests should be ordered, including a complete blood count, differential, and blood culture.

  • Antibiotic therapy – Since orbital cellulitis is commonly caused by Staphylococcus and Streptococcus species, both penicillins and cephalosporins are typically the best choices for IV antibiotics. However, due to the increasing rise of MRSA (methicillin-resistant Staphylococcus aureus) orbital cellulitis can also be treated with Vancomycin, Clindamycin, or Doxycycline. If improvement is noted after 48 hours of IV antibiotics, healthcare professionals can then consider switching a patient to oral antibiotics (which must be used for 2–3 weeks).[citation needed]
  • Surgical intervention – An abscess can threaten the vision or neurological status of a patient with orbital cellulitis, therefore sometimes surgical intervention is necessary. Surgery typically requires drainage of the sinuses and if a subperiosteal abscess is present in the medial orbit, drainage can be performed endoscopically. Post-operatively, patients must follow up regularly with their surgeon and remain under close observation.[citation needed]
  • Corticosteroids - Complications of orbital cellulitis may arise as a result of swelling from the infection. Because the orbit is a small space, increasing the pressure inside can harm the eye. Steroids are drugs that are used to reduce swelling caused by various illnesses, but they can also weaken the immune system's ability to fight the infection. There is inadequate evidence to draw judgments about the use of steroids in the treatment of orbital cellulitis. More research is needed to inform decision making.[11]

Although orbital cellulitis is considered an ophthalmic emergency, the prognosis is good if prompt medical treatment is received.[citation needed]

Death and blindness rates without treatment

Bacterial infections of the orbit have long been associated with a risk of devastating outcomes and intracranial spread.[citation needed]

The natural course of the disease, as documented by Gamble (1933), in the pre-antibiotic era, resulted in death in 17% of patients and permanent blindness in 20%.[12]

Orbital cellulitis is an uncommon medical condition, with the reported rates being much higher among the pediatric population compared to the adult population.[3] One study reported that children are approximately 16 times more likely to suffer from orbital cellulitis compared to adults.[13] It is twice as common among male children compared to female children.[1] Some studies reported that orbital cellulitis follows a seasonal pattern, with the highest rates occurring during the fall and winter, which coincides with the higher rates of sinus infection during the colder months.[14]

  1. 1 2 Nageswaran, Savithri; Woods, Charles R.; Benjamin, Daniel K.; Givner, Laurence B.; Shetty, Avinash K. (2006). "Orbital Cellulitis in Children". The Pediatric Infectious Disease Journal. 25 (8): 695–699. doi:10.1097/01.inf.0000227820.36036.f1. ISSN 0891-3668. PMID 16874168. S2CID 23453070.
  2. 1 2 Garcia, G (2000-08-01). "Criteria for nonsurgical management of subperiosteal abscess of the orbit Analysis of outcomes 1988–1998". Ophthalmology. 107 (8): 1454–1456. doi:10.1016/s0161-6420(00)00242-6. ISSN 0161-6420. PMID 10919887.
  3. 1 2 3 4 Tsirouki, Theodora; Dastiridou, Anna I.; Ibánez flores, Nuria; Cerpa, Johnny Castellar; Moschos, Marilita M.; Brazitikos, Periklis; Androudi, Sofia (2018). "Orbital cellulitis". Survey of Ophthalmology. 63 (4): 534–553. doi:10.1016/j.survophthal.2017.12.001. ISSN 0039-6257. PMID 29248536. S2CID 3534108.
  4. 1 2 Ruiz Carrillo, José Daniel; Vázquez Guerrero, Edwin; Mercado Uribe, Mónica Cecilia (2017-03-01). "Orbital cellulitis complicated by subperiosteal abscess due to Streptococcus pyogenes infection". Boletín Médico del Hospital Infantil de México (English Edition). 74 (2): 134–140. doi:10.1016/j.bmhime.2017.11.020. ISSN 2444-3409.
  5. 1 2 Howe, L.; Jones, N. S. (2004-12-01). "Guidelines for the management of periorbital cellulitis/abscess". Clinical Otolaryngology and Allied Sciences. 29 (6): 725–728. doi:10.1111/j.1365-2273.2004.00889.x. ISSN 1365-2273. PMID 15533168.
  6. ↑ Branson, Sara V.; McClintic, Elysa; Yeatts, R. Patrick (2018). "Septic Cavernous Sinus Thrombosis Associated With Orbital Cellulitis". Ophthalmic Plastic and Reconstructive Surgery. 35 (3): 272–280. doi:10.1097/iop.0000000000001231. ISSN 0740-9303. PMID 30320718. S2CID 52980567.
  7. ↑ O., Chaudhry, Imtiaz A. Al-Rashed, Waleed Arat, Yonca (2012). "The Hot Orbit: Orbital Cellulitis". Middle East African Journal of Ophthalmology. 19 (1). Medknow Publications & Media Pvt Ltd: 34–42. doi:10.4103/0974-9233.92114. OCLC 806537339. PMC 3277022. PMID 22346113.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  8. 1 2 Mejia, Ernesto; Braiman, Melvyn (2018), "Ocular Cellulitis", StatPearls, StatPearls Publishing, PMID 30020691, retrieved 2018-11-25
  9. ↑ Hood, C T (2009-07-24). "The Wills eye manual: office and emergency room diagnosis and treatment of eye disease". British Journal of Ophthalmology. 93 (8): 1127–1128. doi:10.1136/bjo.2008.152355. ISSN 0007-1161. S2CID 72653095.
  10. ↑ Mbbs, M P Ferguson; Fraco, A A McNab (1999). "Current treatment and outcome in orbital cellulitis". Australian and New Zealand Journal of Ophthalmology. 27 (6): 375–379. doi:10.1046/j.1440-1606.1999.00242.x. ISSN 0814-9763. PMID 10641894.
  11. ↑ Kornelsen, Emily; Mahant, Sanjay; Parkin, Patricia; Ren, Lily Yuxi; Reginald, Yohann A; Shah, Samir S; Gill, Peter J (2021-04-28). Cochrane Eyes and Vision Group (ed.). "Corticosteroids for periorbital and orbital cellulitis". Cochrane Database of Systematic Reviews. 2021 (4) CD013535. doi:10.1002/14651858.CD013535.pub2. PMC 8092453. PMID 33908631.
  12. ↑ GAMBLE, R. C. (1933-10-01). "Acute Inflammations of the Orbit in Children". Archives of Ophthalmology. 10 (4): 483–497. doi:10.1001/archopht.1933.00830050059008. ISSN 0003-9950.
  13. ↑ Murphy, C; Livingstone, I; Foot, B; Murgatroyd, H; MacEwen, C J (2014-06-17). "Orbital cellulitis in Scotland: current incidence, aetiology, management and outcomes: Table 1". British Journal of Ophthalmology. 98 (11): 1575–1578. doi:10.1136/bjophthalmol-2014-305222. ISSN 0007-1161. PMID 24939424. S2CID 206873221.
  14. ↑ Ivanišević, Milan; Ivanišević, Petar; Lešin, Mladen (2018-10-29). "Epidemiological characteristics of orbital cellulitis among adult population in the Split region, Croatia". Wiener Klinische Wochenschrift. 131 (9–10): 205–208. doi:10.1007/s00508-018-1402-4. ISSN 0043-5325. PMID 30374774. S2CID 53102990.
  • Noel LP, Clarke WN, MacDonald N (1990). "Clinical management of orbital cellulitis in children". Canadian Journal of Ophthalmology. 25 (1): 11–16. PMID 2328431.
  • Shapiro E, Wald E, Brozanski B (1982). "Periorbital cellulitis and paranasal sinusitis: a reappraisal". Pediatric Infectious Disease. 1 (2): 91–94. doi:10.1097/00006454-198203000-00005. PMID 7177909. S2CID 24237202.