Periorbital cellulitis is a serious infection affecting the tissues around the eye or the orbital cavity. This condition often leads to symptoms like pain, restricted eye movement, and possible vision loss.
Often referred to as orbital cellulitis, it typically develops from untreated sinus infections or ear infections. It may also occur as a result of facial injuries or recent eye surgeries.
Medical care is generally managed by an ophthalmologist and frequently requires the use of intravenous antibiotics. In certain complex situations, surgical intervention may be needed to effectively treat the infection.
Common symptoms
The primary symptoms of periorbital cellulitis include:
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Eye pain, especially when shifting your gaze;
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Swelling and redness of the eyelids;
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Redness within the eye itself;
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Double vision;
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Blurred vision or difficulty seeing clearly;
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A general sense of being unwell and extreme fatigue;
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Fever.
Periorbital cellulitis typically affects only one eye. It can also present signs of a medical emergency, such as a significant decrease in vision, compromised pupillary reflexes, or changes in how you perceive colors.
In severe cases, there is a risk of dangerous complications like meningitis or cavernous sinus thrombosis.
Confirming a diagnosis
An ophthalmologist diagnoses periorbital cellulitis by evaluating symptoms and performing a comprehensive eye exam, sometimes collaborating with an ear, nose, and throat (ENT) specialist if a sinus infection is suspected.
To confirm the diagnosis, doctors use imaging tests, primarily a CT scan of the eye socket and sinuses, which may be supplemented by an MRI for more detail.
Additional lab work, such as a complete blood count (CBC) and blood cultures, may be ordered to check for microorganisms in the bloodstream that could be fueling the infection.
Possible causes
Periorbital cellulitis can be triggered by several factors, including:
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Bacterial sinusitis;
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Eye injuries or blunt force trauma;
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Infections affecting the face;
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Dental infections;
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Middle ear infections (otitis media);
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Complications from eye surgery.
The infection is most commonly caused by bacteria such as Staphylococcus aureus and Streptococcus.
Pediatric periorbital cellulitis
In children, periorbital cellulitis can progress very quickly and requires immediate medical attention. It causes pain, swelling, and difficulty moving the eye, and in advanced cases, it can lead to permanent vision impairment.
How to treat
Treatment for periorbital cellulitis typically involves the following approaches:
1. Medication
Because the infection can spread rapidly, treatment must begin immediately and usually requires hospital admission for the administration of intravenous (IV) antibiotics.
Doctors often start with broad-spectrum antibiotics like ceftriaxone, vancomycin, or amoxicillin-clavulanate for approximately three days before the specific bacteria is identified.
Once the condition stabilizes, treatment may continue at home with oral antibiotics, such as clindamycin or amoxicillin, for a total course of 8 to 20 days depending on the severity.
After lab results identify the specific microorganism causing the infection, the doctor may adjust the prescription to a more targeted and effective antibiotic.
2. Surgery
Surgical intervention is reserved for specific situations, such as the presence of an abscess in the eye socket or brain, compression of the optic nerve, or if the infection fails to improve with medication.
The procedure is used to drain fluid collections around the eye, relieve orbital pressure, remove infected tissue, and ultimately save the patient's vision.
Is periorbital cellulitis contagious?
Periorbital cellulitis is not contagious and cannot be passed from person to person. It generally develops from localized internal infections, such as sinusitis or dental issues, or from physical trauma that reaches the orbital area.