Orbital Cellulitis: Symptoms, Causes, and Treatments - Healthline

Orbital cellulitis is an infection of the soft tissues and fat that hold the eye in its socket. This condition causes uncomfortable or painful symptoms.

It's not contagious, and anyone can develop the condition. However, it most commonly affects young children.

Orbital cellulitis is a potentially dangerous condition. When left untreated, it can lead to blindness, or serious or life-threatening conditions.

Causes

Streptococcus species and Staphylococcus aureus are the most common types of bacteria that cause this condition. However, other bacterial strains and fungi can also be the cause of this condition.

Orbital cellulitis in children ages 9 and under is usually caused by only one type of bacteria. In older children and adults, this infection can be caused by multiple strains of bacteria simultaneously, making it harder to treat.

Up to 98 percent of all cases of orbital cellulitis start out as untreated bacterial sinus infections, which spread behind the orbital septum. The orbital septum is a thin, fibrous membrane that covers the front of the eye.

This condition can also spread from a tooth infection or a bacterial infection occurring anywhere in the body that enters the blood stream.

Wounds, bug bites, and animal bites that occur in or near the eye may also be the cause.

Symptoms

Symptoms are the same in both children and adults. However, children may display more severe symptoms.

Symptoms include:

• protruding eye, which may be severe, also called proptosis
• pain in or around the eye
• nasal tenderness
• swelling of the eye area
• inflammation and redness
• inability to open the eye
• trouble moving the eye and pain upon movement of the eye
• double vision
• vision loss or impaired vision
• discharge from the eye or nose
• fever
• headache

Diagnosis

Orbital cellulitis is often diagnosed through a healthcare provider's visual evaluation. However, diagnostic tests will be done to confirm the diagnosis and to determine what type of bacteria is causing it.

Testing will also help your healthcare provider see if the infection is preseptal cellulitis, a less serious bacterial eye infection that also requires immediate treatment.

This occurs in eyelid tissue and in the front of the orbital septum rather than behind it. This type can progress to orbital cellulitis if it's left untreated.

A few different tests can be done for diagnosis:

• CT scan or MRI of the head, eye, and nose
• examination of the nose, teeth, and mouth
• blood, eye discharge, or nasal cultures

Treatment

If you have orbital cellulitis, you'll most likely be admitted into the hospital to receive intravenous (IV) antibiotics.

Antibiotics

Given the potential severity of this condition and the speed with which it spreads, you'll be started on broad-spectrum IV antibiotics immediately, even if your diagnostic test results haven't yet confirmed the diagnosis.

Broad-spectrum antibiotics are typically given as a first course of treatment because they're effective at treating many types of bacterial infections.

If the antibiotics you receive don't help you improve quickly, your healthcare provider may change them.

Surgery

If your symptoms don't improve or if they worsen while you're on antibiotics, surgery may be required as a next step.

Surgery will help to stop the progression of the infection by draining fluid from the sinuses or the infected eye socket.

This procedure may also be done to drain an abscess if one forms. Adults are more likely to need surgery than children.

Recovery time

If your condition requires surgery, your recovery time and hospital stay may be longer than it would be if you were treated only with antibiotics.

If surgery wasn't done and you improve, you can expect to transition from IV to oral antibiotics after 1 to 2 weeks. Oral antibiotics will be needed for another 2 to 3 weeks or until your symptoms completely disappear.

If your infection stems from severe ethmoid sinusitis, an infection of the sinus cavities located near the bridge of your nose, you may be required to take antibiotics for a longer period of time.

Having orbital cellulitis doesn't mean you'll get it again.

However, if you're prone to recurring sinus infections, it's important that you monitor and treat your condition quickly. This will help to prevent the condition from spreading and causing a recurrence.

This is particularly important in people who have compromised immune systems or young children who don't have fully formed immune systems.

When to see a doctor

If you have a sinus infection or any symptoms of orbital cellulitis, call your healthcare provider immediately. This condition spreads very quickly and must be treated as early as possible.

Severe complications can occur when orbital cellulitis is not treated.

Complications can include:

• partial vision loss
• complete blindness
• retinal vein occlusion
• meningitis
• cavernous sinus thrombosis

The bottom line

Orbital cellulitis is a bacterial infection in the eye socket. It usually starts out as a sinus infection and typically affects children.

This condition usually responds well to antibiotics, but it sometimes requires surgery. It can cause blindness or life-threatening conditions if it's left untreated.