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Cellulitis of the Eye (Orbital Cellulitis)

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Orbital cellulitis is a dangerous infection of the fat and muscles around the eye. Somewhat related is the less serious periorbital cellulitis, which is an infection of the skin around the eye, including the eyelid.

Both of these conditions should be treated as soon as possible. Orbital cellulitis can cause permanent complications, and periorbital cellulitis can become orbital cellulitis in rare cases.

What Is Cellulitis of the Eye?

Cellulitis of the eye, encompassing periorbital and orbital cellulitis, refers to a bacterial infection affecting the tissues around the eye. Periorbital cellulitis involves the eyelid and skin around the eye, while orbital cellulitis, a more serious condition, impacts the fat and muscle within the eye socket.

Both conditions share some common symptoms like redness and swelling around the eye, but orbital cellulitis displays additional symptoms, including painful eye movement, bulging of the eye, and even fever. The more severe condition, orbital cellulitis, is considered a medical emergency due to its potential to cause serious complications, including vision loss.

Prompt medical attention is crucial if symptoms of either condition are present. While these conditions are technically contagious, in practical terms, the spread is rare. Prevention includes timely treatment of infections, vaccination in children, and occasionally, prophylactic antibiotic treatment for those in close contact with an infected individual.

cellulitis of the eye

Causes of Cellulitis of the Eye

Both orbital cellulitis and periorbital cellulitis are caused by bacteria, most commonly in children. Unfortunately, children are also most vulnerable to the long-term harm that orbital cellulitis can cause.

These bacteria are known to cause orbital cellulitis:

  • Haemophilus influenzae
  • Staphylococcus aureus
  • Streptococcus pneumoniae

Serious orbital cellulitis used to be a common concern for children under 7, but vaccination has sharply reduced its occurrence.

Fungi can also cause cellulitis if the patient is immunocompromised.

Who Does Cellulitis of the Eye Affect?

Cellulitis of the eye can affect individuals of all age groups, but it’s more commonly seen in children, particularly those under the age of seven. The frequency among children is primarily due to their increased susceptibility to the types of bacteria that commonly cause these infections.

In adults, periorbital or orbital cellulitis can occur following trauma to the eye or face, surgery, or the spread of an infection from a nearby area such as the sinuses or teeth. Adults with compromised immune systems, such as those with diabetes, HIV/AIDS, or those undergoing treatments like chemotherapy, are at higher risk due to their diminished ability to fight off infections.

The condition isn’t limited to any specific geographical region or ethnicity. It’s important to note that good personal hygiene, prompt treatment of facial and eye injuries, and maintaining a robust immune system can help reduce the risk of developing cellulitis of the eye in both children and adults.

Symptoms of Eye Cellulitis

These are symptoms of periorbital cellulitis:

  • Redness around the eye
  • Redness in the eye
  • Swelling of the eyelid
  • Swelling of the whites of the eye
  • Eye pain (rare)

These are symptoms of orbital cellulitis:

  • Painful swelling of the eyelid
  • Eyebrow brown
  • Sore swelling of the cheek
  • Bulging eyes
  • Pain when moving the eye
  • Difficulty moving the eye
  • Red or purple eyelid
  • Decreased vision, potentially with double vision
  • Fever

A person experiencing any of the above symptoms needs medical attention right away. Orbital cellulitis can cause permanent vision problems if not treated quickly. It should be treated as a medical emergency, and the person should be brought to the hospital as soon as possible.

Diagnosing Cellulitis of the Eye

Doctors have several options to help diagnose these conditions and determine their severity. A patient can expect several blood tests and a blood culture. They may also get a CT and MRI scan.

Orbital cellulitis may involve further testing, including x-rays, an eye and throat culture, and nasal drainage. While the doctor can likely determine the broad problem before these tests, this helps them further tailor the treatment a patient receives for the best outcome possible.

Severe cases of orbital cellulitis may require a patient to get a spinal tap, although this is rare.

Dangers of Orbital Cellulitis

One of the most serious outcomes a patient may experience from orbital cellulitis is optic nerve damage. Damage to the optic nerve can cause permanent loss of vision, including blindness. A serious infection like orbital cellulitis can also cause hearing loss.

Other potential complications can include the following:

  • Meningitis
  • Septicemia (sepsis)
  • Cavernous sinus thrombosis (blood clot near the base of the brain)

Treatment for Cellulitis of the Eye

Both forms of cellulitis of the eye can be treated with antibiotics. Surgery may also be used to drain abscesses and relieve pressure around the eye, to reduce any risk of optic nerve damage.

With periorbital cellulitis, the need for surgery is rare and antibiotics may be given in several ways, including by mouth or shot. With orbital cellulitis, speed is a priority, so surgery is much more common. Antibiotics will almost always be administered as directly as possible into the veins.

Prevention of Eye Cellulitis

To prevent orbital cellulitis, always make sure infections receive prompt medical attention even if they seem minor. Sinus and dental infections are the most likely types of infections to evolve into orbital cellulitis.

Making sure a child gets all their recommended vaccinations, specifically their Hib vaccine shots, is the best way to protect them from orbital cellulitis. Their risk of this infection is much lower when vaccinated.

Children near people who have this infection may be given an antibiotic course as a preventative measure, to help them from getting sick.

Is Cellulitis Contagious?

Technically, cellulitis is contagious, but it usually isn’t in the practical sense.

Because of where the infection occurs, infection is only likely to spread if direct contact with the infected individual’s bodily fluids, specifically blood, occurs. This is rare, but you can discuss the potential with a doctor and still mention any close contact you’ve had with the patient.

Cellulitis of the Eye FAQs

How long does cellulitis of the eye take to heal?

Like any infection, the time it takes cellulitis to heal depends on the severity of the infection and how promptly a person got treatment.

The first few days of treatment are the most serious, especially in young children. Eventually, as the swelling goes down, the patient can begin taking oral medication and go home, although with frequent follow-ups with a medical professional.

A patient can expect to take antibiotics for at least two to three weeks, possibly more in severe cases. It is important to take all your medication as prescribed, even if you feel better or your symptoms seem to be gone.

If you fail to take all the medication your doctor prescribed, the small amount of bacteria left in your body may cause you to experience serious symptoms again, as you give the bacteria a chance to multiply.

What causes ocular cellulitis?

Several things can cause periorbital and orbital cellulitis. Infected insect bites are one common source of infection, as is the spreading of bacteria from already infected parts of the body, such as from a sinus infection.

What does cellulitis of the eye look like?

Periorbital and orbital cellulitis are usually both quite obvious. The eyelid and possibly the cheek will be swollen, and the skin around the eye will likely have some discoloration.

The infection may superficially look similar to that of a black eye or similar injury, although it is usually much more serious.

References

  1. Orbital Cellulitis. (August 2021). StatPearls.
  2. Orbital Cellulitis. (October 2020). MedlinePlus.
  3. Periorbital Cellulitis. (November 2019). MedlinePlus.
  4. Emergency Management: Orbital Cellulitis. (2018). Community Eye Health Journal.
  5. Fatal Orbital Cellulitis With Intracranial Complications: A Case Report. (November 2018). International Journal of Emergency Medicine.
  6. Chew on This. (March 2020). Review of Optometry.
  7. Preseptal Cellulitis. (April 2022). American Academy of Ophthalmology.
  8. Periorbital and Orbital Cellulitis. (January 2020). JAMA.

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