Back to Basics: Orbital Cellulitis

Orbital Cellulitis
  • Infection of the soft tissue surrounding the orbit posterior to orbital septum
  • Results from extension of infection from sinuses, or due to respiratory infection, insect bite or trauma
  • Often polymicrobial - S. aureusS. pneumoniae, anaerobes. Consider H. influenza in unimmunized, Mucormycosis in diabetics and unimmunized.
Signs and Symptoms:
  • Preceding URI symptoms
  • Fever
  • Pain with extraocular movements, limited extraocular movements, limited pupillary response
  • Chemosis, proptosis
Management:
  • Broad spectrum antibiotics - 2nd/3rd gen cephalosporin or unasyn
  • CT orbits
  • Optho evaluation
  • Lateral canthotomy if increased intraocular pressure or optic neuropathy
Complications:
  • Cavernous sinus thrombosis - consider if cranial nerve palsy
  • Frontal bone osteomyelitis
  • Meningitis
  • Epidural or brain abscess

 

  • References:
  • Walker, RA, Adhikari, S. "Eye Emergencies." Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8eEds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016, Ch 241.