Orbital Cellulitis

Orbital cellulitis is an acute infection that involves the fatty orbital tissues and eyelids but not the eyeball. With treatment, the prognosis is good.

Causes

Orbital cellulitis usually results from infection of nearby structures - typically by streptococcal, staphylococcal, and pneumococcal organisms. In children orbital cellulitis may follow Haemophilus influenzae infection. These organisms invade the orbit, commonly by direct extension through the sinuses (especially the ethmoid sinus), the bloodstream, or the lymphatic ducts.

Primary orbital cellulitis results from orbital injury (such as an insect bite) that permits bacterial entry. Although this disease form is common in young children, it also affects people with poor dental hygiene and those who snort cocaine.

Symptoms

The following are the most common symptoms of Orbital cellulitis. However, each child may experience symptoms differently. Symptoms appear abruptly and may include:

• Swelling of the upper and lower eyelid
• Infant or child is acutely ill or toxic.
• Redness of the upper and lower eyelid
• Warmth of skin
• Decreased vision (because the lid is swollen over the eye).
• Pain
• Fever
• Restricted or painful eye movements.

Diagnostic tests

Wound culture and sensitivity testing may be done to identify the infecting organism. A white blood cell count typically reveals leukocytosis.

Treatment

To prevent complications, treatment should begin promptly. Primary treatment consists of systemic oral or I.V. antibiotics and eyedrops or ointment. Supportive treatment consists of bed rest, fluids, and warm, moist eye compresses. If cellulitis fails to respond to antibiotics after 3 days, incision and drainage may be necessary.

Prevention

Immunization with HiB vaccine according to recommended schedules generally will prevent most hemophilus infection in children. Young children in the same household who have been exposed may receive the prophylactic antibiotic Rifampin, although this generally is reserved for siblings exposed to other hemophilus diseases such as meningitis and septicemia.

Proper evaluation and early treatment of sinus, dental, or other infections may prevent the spread of infection to the eyes.

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