Orbital Cellulitis (Periorbital Cellulitis)

The terms orbital cellulitis and periorbital cellulitis refer to an inflammation and infection of the tissue and skin surrounding the eye. Periorbital cellulitis involves the area from the skin of the eyelid to the bony area that encloses the eye. Orbital cellulitis is an infection that involves the eye and the eye structures within the bony cavity of the face.

• Both conditions are serious and require immediate medical attention from your child's physician. Complications can include meningitis, loss of vision, or brain abscess.
• Although characterized by swelling around the eye, the eyeball is usually not affected and appears normal.
• The most common cause of these types of cellulitis stems from bacterial infection, either by direct trauma or by an infection that spreads from the sinuses.

Although each child may experience symptoms differently, the most common symptoms of periorbital cellulitis appear abruptly and may include:

• Swelling of the upper and lower eyelid
• Redness of the upper and lower eyelid
• Pain
• Fever
• General discomfort of the eye

The eyeball is usually not affected and appears normal.

Although each child may experience symptoms differently, the most common symptoms of orbital cellulitis appear slowly and may include:

• Swelling of the upper and lower eyelid
• Swelling and bulging of the eyeball
• Decrease in the child's ability to move the eyeball
• Decrease in vision
• Fever
• General discomfort

The most common cause of these types of cellulitis stems from bacterial infection. The bacteria that are usually involved are:

• Staphylococcus aureus
• Streptococcus pyogenes
• Haemophilus influenzae

Bacteria gets into the eye and the surrounding cavity many different ways. The two most common ways the infection gets into the eye include:

• Trauma: Direct trauma to the eye can lead to infection from the bacteria.
• Spread from other areas: Most commonly, the infection begins in the sinuses. The sinuses are cavities, or air-filled pockets, that are near the nasal passage.

Diagnosis is usually based on a complete medical history and physical examination of your child. In addition, your child's physician may order the following tests to help confirm the diagnosis:

• Blood tests
• X-ray: a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film
• Computerized tomography scan (also called a CT or CAT scan): A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images of the body
• Cultures of the drainage from the eyes

Treatment for periorbital cellulitis usually includes oral antibiotics. Close follow-up with your child's physician is necessary for constant monitoring.

Orbital cellulitis is a serious condition and must be treated promptly. Treatment may include:

• Hospitalization: Your child may be admitted to the hospital for antibiotics through an intravenous (IV) catheter. Hospitalization also allows for close evaluation of your child and the condition.
• Surgery: Surgical drainage of the sinuses or any abscesses of the eye is sometimes needed.

The risk of complications may be reduced with prompt and accurate treatment of the problem. But the most common complications that may occur are:

• Meningitis (an infection of the outside of the brain and the spinal cord)
• Loss of vision
• Brain abscess (with the possibility of permanent neurologic deficits)