Orbital Cellulitis: Overview and More

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Orbital cellulitis is a severe infection of the muscles, fat, and tissues located around the eye. It can also affect the cheeks, eyelids, and eyebrows. It occurs more commonly in children than adults, although it can affect people of any age.

Orbital cellulitis generally stems from an infection of the sinuses or face or from trauma to the eye. It requires urgent medical care and can lead to blindness if left untreated.

This article provides an overview of orbital cellulitis, as well as its symptoms, causes, diagnosis, and treatment.

Man rubbing his eye

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Orbital Cellulitis vs. Periorbital Cellulitis

There is only one primary type of orbital cellulitis. However, it is sometimes confused with another condition called periorbital cellulitis. It's essential to understand that they are different infections that affect different areas of the eye.

Where They Occur

Periorbital cellulitis is an infection of the area around the eye and the eyelid. Orbital cellulitis is an infection of the tissues around the eyeball and the deeper tissues behind the eye.

Periorbital cellulitis usually stems from an insect bite or irritation to the eye. This infection leads to redness, pain, and swelling around the eye. However, vision remains normal, and the person can still move the eye in all directions.

Orbital cellulitis usually is caused by an infection in the sinuses or other parts of the face, trauma to the eye, or as a result of periorbital cellulitis. Without treatment, it can lead to blindness.

Orbital Cellulitis Symptoms

Orbital cellulitis symptoms can include:

  • Pain and swelling of the upper and lower eyelid
  • Pain and swelling of the eyebrow and cheek
  • Red or purple eyelid, or shiny skin on the eyelid
  • Double or blurry vision
  • Difficulty moving the eye
  • Fever
  • Bulging eyes, also called proptosis
  • Less pupil reaction
  • Blindness

Orbital cellulitis can turn into a pocket of pus, called an abscess, behind or around the eye.

Causes

Orbital cellulitis is usually caused by a bacterial sinus infection, also known as sinusitis. Although bacterial sinus infections are relatively common, orbital cellulitis is very rare.

Other causes of orbital cellulitis may include:

  • Trauma to the eyeball
  • An infection of the tear duct, face, ear, or teeth

There are a few types of bacteria that are most commonly responsible for causing orbital cellulitis:

  • Haemophilus influenza
  • Staphylococcus aureus
  • Streptococcus pneumoniae
  • Beta-hemolytic streptococci

Diagnosis

Prompt diagnosis of orbital cellulitis is critical because the condition can lead to permanent vision problems and blindness.

Diagnostic tests may include:

Noninvasive diagnostic imaging of the sinuses, eye, and surrounding area may include:

Treatment

Treatment for orbital cellulitis may include some of the following:

  • Intravenous (IV) antibiotic therapy
  • Surgery to drain an abscess and relieve pressure around the eye
  • Nasal decongestants to provide some relief for nasal congestion due to a sinus infection or other nose blockage
  • Oral antibiotics after hospital discharge

For people who have chronic sinusitis, a healthcare provider might recommend a procedure called functional endoscopic sinus surgery (FESS) to prevent sinus infections that could lead to orbital cellulitis.

Prognosis for Orbital Cellulitis

Most people with orbital cellulitis require hospitalization for treatment and observation. This condition can worsen quickly, and your healthcare provider may want to monitor your progress to ensure that your treatment is effective. The outlook for people with orbital cellulitis is very good with early treatment. However, a delay in treatment can lead to permanent vision problems or blindness.

Summary

Orbital cellulitis is a severe infection of the tissues around the eyeball that requires urgent attention. It generally stems from an infection of the sinuses or face, or other trauma.

Orbital cellulitis symptoms can include pain and swelling of the eyelids, eyebrow, and cheek. Other symptoms include double or blurry vision, difficulty moving the eye, fever, bulging eyes, and lower pupil reaction. It can lead to blindness if not diagnosed and treated promptly.

Most people with orbital cellulitis require a hospital stay for observation, antibiotic treatment, and sometimes surgery.

A Word From Verywell

Prompt treatment for orbital cellulitis is essential for a complete recovery without permanent vision damage or loss. Always contact your healthcare provider if you suddenly experience symptoms of orbital cellulitis, especially if you have or recently had a sinus infection. They can ensure you have the best treatment to improve symptoms and avoid vision loss.

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4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Baiu I, Melendez E. Periorbital and orbital cellulitisJAMA. 2020;323(2):196. doi:10.1001/jama.2019.18211

  3. American Academy of Ophthalmology. Orbital cellulitis.

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