Orbital cellulitis

Orbital cellulitis is an infection of the tissues of the orbit which are located at the back of the orbital septum. It can affect the eyelid, cheeks and eyebrows. The infection can be caused by local injuries (insect bites or penetrating eye injuries) or by the spread of contiguous facial infections.

This infection can become serious, causing even blindness, so it is very important to know the symptoms and treat them properly. Likewise, it is important to differentiate orbital cellulitis from periorbital or preseptal cellulitis, that occurs in front of the orbital septum and not in it.

Causes of the orbital cellulitis

Orbital cellulitis is caused by the appearance of adjacent centres of fulminant infection that can be caused by:

• An infection in the paranasal sinuses (e.g., in case of sinusitis)
• Penetrating eye trauma
• The bite of an animal or an insect
• An oral and/or tooth infection
•  A dermatological infection on the face
• Recent eye or facial surgery
• An infection of the tear duct

Symptoms of orbital cellulitis

Factors to be taken into account for the detection of this pathology are:

Redness and swelling of the eyelids (erythema and oedema) together with any of the following symptoms:

• Anterior displacement of the eyeball
• Double vision (diplopia)
• Decrease in ocular motility
• Fever
• Loss of vision (infrequent)
• Eye pain
• Signs of primary infection (nasal discharge and sinusitis)

How is it diagnosed?

If you notice any of these symptoms, it is very important to go immediately to the ophthalmologist to receive a diagnosis. The ophthalmologist will explore your eyes, nose, eyelids and face.

The diagnosis will be mainly made after having the following results:

• Clinical evaluation: the ophthalmologist will check your eye pressure, the motility of the eyes and the state of your vision. The specialist can also request a blood test or a culture of liquids to determine the type of bacteria causing the infection (treptococcuspneumoniae, staphylococcusaureus, Streptococcuspyogenes,etc).
• Imaging tests: if the clinical evaluation is not enough, you may be prescribed a computed tomography scan (CT scan) or, less frequently, an MRI to observe the magnitude of the infection and the affected areas.

How to treat orbital cellulitis?

Once the pathology has been diagnosed, the ophthalmologist will proceed to prescribe the most appropriate treatment.

Preseptal cellulitis is treated with oral antibiotics and on an outpatient basis (the patient is not admitted into the hospital)

Orbital cellulitis is usually treated in the hospital. The treatment includes:

• Systemic antibiotics: they are usually administered intravenously and serve to attack the bacterial infection.
• Steroids: can be prescribed to reduce inflammation or swelling caused by the infection several days after starting the antibiotic
• Analgesics: they are prescribed to relieve pain.

Likewise, in some cases it will be necessary to resort to surgery to decompress the orbit and perform a drainage of liquids and abscess if the infection does not improve with pharmacological treatment.

How to prevent orbital cellulitis?

The causes of this pathology are usually the extension of a contiguous infection or an infection caused by a penetrating ocular traumatism. Therefore, before any sign of having an infection in the area of the face, it is necessary to go urgently to the doctor to prevent its spread.

It is recommended to use the appropriate safety equipment when practicing sports or doing activities that may pose a risk for your eyes.

This pathology commonly affects children. Therefore, it is important to be vigilant if they show any type of symptom that may indicate an infection, especially in the case of those children who are prone to sinusitis.