Orbital cellulitis is an acute infection of the tissues immediately surrounding the eye.
Causes, incidence, and risk factors
Orbital cellulitis is a dangerous infection with potentially serious complications. It is usually caused by a bacterial infection from the sinuses (ethmoid or para-nasal). Other causes are a stye on the eyelid, recent trauma to the eyelid including bug bites, or a foreign object. In children, orbital cellulitis is usually from a sinus infection and due to the organism Hemophilus influenzae . Other organisms such as Staphlococcus aureus , Streptococcus pneumoniae , and Beta hemolytic streptococci may also cause this condition.
Infants and children up through age 6 to 7 years-old seem to be particularly susceptible to infection with Hemophilus influenzae , and are most at risk. The incidence of severe disease has decreased steadily since the introduction of HiB vaccine (Hemophilus influenzae B ). Risk factors include sinus infections or injury to the eyelid including bug bites.
Signs and tests
Tests commonly include:
A CBC (complete blood count)
Blood culture and sensitivity A spinal tap in extremely sick children Other tests may include:
An X-ray of the sinuses and orbit
A CT scan or MRI of the sinuses and orbit
A culture of eye drainage A culture of nose drainage A throat culture
A blood culture
Treatment
Hospitalization is always required. Treatment consists of IV fluids with antibiotics. Surgical drainage of an abscess may be necessary. These infections can progress rapidly, and they must be carefully followed every few hours.
Expectations (prognosis)
With early recognition and treatment, the patient can be expected to recover fully.
Calling your health care provider
This condition is considered a major ophthalmologic emergency that requires immediate treatment. Call your physician if your child exhibits any swelling of the eyelid, especially if it is associated with fever.
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 eye(s).