Orbital Cellulitis

What is orbital cellulitis?

Orbital Cellulitis is an uncommon condition in which an infection has breached or circumvented the outer portion of the eye and affected the tissues of the orbit, also known as the eye socket. The orbit provides a place for the eye and its muscles, nerves, and fatty tissue to work together in order to move and provide vision.

Symptoms will vary depending on the severity of the infection. Early symptoms include inflammation, redness, pain, and limited movement of the eye. More progressive symptoms include changes in vision, a dilated pupil, a sudden lazy eye, or an appearance that the eye is bulging out of its socket. Fever and a general ill feeling may also be present.

Treatments include antibiotics and possible surgery to repair any damage to structures of the eye.

You should seek immediate medical care at an urgent care clinic or ER. Antibiotics are given immediately to treat the infection, even before results from the laboratory have come back. You may likely be hospitalized as well.

Orbital cellulitis symptoms

If untreated, an infection of the orbit can put both your sight and life at risk. It is important to recognize both signs of early infection as well as take action if more severe damage seems to be present.

Signs of early infection

These symptoms indicate the infection has not yet compromised or started to damage the nerves or muscles of the eye. These symptoms of inflammation may manifest as:

• Redness and swelling around the eye: Areas include the eyelids, eyebrows, and cheeks.
• Pain and an inability to move the eye: These are common symptoms of tissues responding to an infection.
• Limited eye movement: This is also in response to pain.

Signs of more severe damage

Severe pressure damage to the structures within the eye would manifest as the following signs and would warrant immediate surgical attention:

• Changes in vision: This is a sign that the pressure caused by inflammation and bacteria in the eye is impinging on the ability of the optic nerve to function correctly. This pressure damage can cause permanent vision loss.
• Paralysis or deviation of the pupil
• Dilation of the affected pupil
• A sudden "lazy eye": This is caused by constriction of one of the extraocular muscles (e.g. muscles that move the eye or cause the eye to stay in place).
• Proptosis: The eye may appear to bulge out of its socket.

Causes of orbital cellulitis

Orbital cellulitis is commonly caused by infections of the skull and sinuses, sinusitis, trauma and preseptal or periorbital cellulitis, and other system-wide infections that have spread.

Infections of the skull and sinuses

These infections can often lead to orbital cellulitis if they are not properly cared for. In children, only a thin layer of bone separates the sinuses and skull from the orbit, which any infection can easily traverse.

• An infection in the skull: This area is very dangerous because it is difficult to treat and can hinder the vision of an affected individual.
• An infection of the sinuses: This is often precipitated by an infection of the throat or ear, in which the ethmoid sinus is affected. The infection can extend into the orbit if it continues for long enough.

Sinusitis

Sinusitis is one of the most significant causes of orbital cellulitis (accounting for 90 percent of orbital cellulitis). The aggressiveness of the infection and the antibiotics used vary for the type of bacteria present. As long as the bacteria is not drug-resistant and medical care is sought quickly, the outcome should not be affected.

• In younger children: Streptococcus bacteria, in which many are vaccinated against early in life (e.g. Strep Pneumo, Haemophilus influenzae), are usually the cause.
• In older children: Bacteria that exist in the mouth (e.g. bacteroides, peptostreptococcus) are often the cause.

Trauma and preseptal cellulitis

These causes are slightly less common for orbital cellulitis. If you cannot recall trauma or another infection, your physician will examine for other possibilities.

• Trauma: This can involve an injury, such as a stab wound or from a rock, that becomes infected due to debris and bacteria entering the eye.
• Styes, chalazions, or a transmission of herpes: These conditions fall under preseptal or periorbital cellulitis, as they involve inflammation and infection outside the eye. They can sometimes traverse the orbit and cause orbital cellulitis.

System-wide infection

An infection of another part of the body that has seeded the blood (septicemia) can cause orbital cellulitis. This is more common in HIV-infected or other immunosuppressed children (e.g. those with cancer completing chemotherapy). Common infections that seed the blood include:

• Upper urinary tract infections
• Untreated oral infections
• Lung infections
• Upper respiratory tract infections: Children are especially predisposed to develop orbital cellulitis following this type of infection.

Treatment options and prevention for orbital cellulitis

Treatment includes antibiotics, which may change once your physician has identified the certain bacteria associated. Emergency surgery may also be needed.

Antibiotics

Because different types of bacteria affect the eye, usually your physician will choose a "broad spectrum" antibiotic at first. After they have found the specific bacteria, they will choose a more specific antibiotic. As stated earlier, small children tend to be affected by common skin flora or infections preventable by vaccine, while adolescents tend to suffer infections from bacteria that exist natively in the mouth.

Emergency surgery

Surgery is an emergency intervention used either to prevent loss of sight or life; however, both of these are rare consequences. They are often caused by infection with a rare bacteria or fungus that is difficult to treat, or not seeking treatment before the bacteria spreads to other areas within the brain. Surgery often involves entering the orbit usually from the back of the throat, and draining the pus, abscess, and or fluid collection that is contributing to the increased pressure. Surgery is necessary in cases when you experience:

• Vision loss
• Vision changes
• The pupil dilates
• The pupil deviates (e.g. lazy eye)

Prognosis

Treatment drastically reduces the rate of complications such as further infection within the brain or loss of vision or life. Treatment generally begins working within a day or even a few hours if the infection is caught early. Inflammation and swelling should decrease quite rapidly. Some slight redness may remain for up to 10 days afterward. Of course, treatment time depends on the extent of the infection as the bacteria needs to be completely eradicated prior to discharge from the hospital.

When to seek further consultation for orbital cellulitis

Orbital cellulitis is a diagnosis that always necessitates consultation and medical care, the only distinction is at what level and when.

If you begin experiencing symptoms

You should seek medical care upon first suspecting orbital cellulitis. It is a diagnosis that necessitates treatment with antibiotics, and if it is untreated, can lead to vision loss and death [1]. It is important to seek medical help especially if you have recently had:

• Trauma: Including small things like bug bites
• Systemic infection, or a severe sinus infection: Such as respiratory infections or sinusitis
• Painful, red swelling around the periphery of the eye
• A paralyzed eye
• A deviated or dilated pupil
• Loss of vision

In order to prevent further swelling and damage

Given the potentially severe complications of orbital cellulitis, urgent medical care is crucial. If you suspect you have orbital cellulitis, do not delay in seeking emergency treatment. This condition can progress rapidly, potentially leading to vision loss, blood clots, or life-threatening infections if left untreated. When you arrive at the emergency room, expect a thorough eye examination and possibly imaging tests such as CT or MRI scans. Emergency treatment typically involves immediate administration of intravenous antibiotics to combat the infection. In some cases, surgical intervention may be necessary to drain abscesses or relieve pressure within the eye socket. Remember, with orbital cellulitis, every hour counts – prompt medical attention can make a significant difference in preserving your vision and overall health.

You should be evaluated emergently for surgery as further swelling can result in permanent vision loss, severe and life-threatening clots if the infection travels from the orbit into the blood vessels of the brain or even death.