Orbital Cellulitis: Symptoms, Causes, Treatment

What are the symptoms of orbital cellulitis?

Orbital cellulitis is a serious infection of the soft tissues surrounding the eye (the orbit) and is often characterized by several key symptoms. It typically arises as a complication of sinus infections, but can also result from trauma, dental infections, or other causes. Here are the common symptoms of orbital cellulitis:

1. Ocular Symptoms:

• Proptosis: Bulging of the eye (eyeball).
• Eye Pain: Discomfort or severe pain around the eye, especially when moving the eye.
• Reduced Vision: Blurred vision or loss of vision in severe cases.
• Diplopia: Double vision resulting from muscle involvement or pressure on the optic nerve.

2. Swelling and Redness:

• Periorbital Swelling: Swelling of the eyelids and surrounding tissues.
• Erythema: Redness of the skin around the eye.

3. Systemic Symptoms:

• Fever: Often present, indicating an infection.
• Chills: May accompany the fever.
• Fatigue: General malaise or tiredness.

4. Additional Signs:

• Limited Eye Movement: Reduced ability to move the eye normally due to inflammation or pain.
• Tearing: Increased tear production (epiphora).
• Nasal Symptoms: Symptoms related to sinus infection, such as nasal congestion, discharge, or facial pain, may also be present.

Important Considerations:

Orbital cellulitis is considered a medical emergency due to the potential for serious complications, including vision loss and intracranial infections. It is crucial for individuals exhibiting these symptoms, especially with a recent history of sinus infection or any injury around the eye, to seek immediate medical attention. A healthcare provider may perform imaging studies, such as a CT scan, to assess the extent of the infection and to guide management. Early diagnosis and treatment with antibiotics, and sometimes surgical intervention, are vital for preventing complications.

What are the causes of orbital cellulitis?

Orbital cellulitis is an acute infection of the soft tissues surrounding the eye, resulting from various underlying causes. The primary factors contributing to the development of orbital cellulitis include:

1. Sinus Infections (Sinusitis):

• The most common cause of orbital cellulitis is the spread of infection from the paranasal sinuses, particularly the maxillary and ethmoid sinuses. Bacterial sinusitis can lead to inflammation and infection of the periocular tissues.

2. Ocular Conditions:

• Eye Infections: Conditions such as bacterial conjunctivitis or keratitis can potentially extend into the orbit.
• Orbital Surgery: Post-surgical complications from procedures involving the orbit or surrounding areas can introduce bacteria.

3. Trauma:

• Facial Injuries: Fractures of the orbital bone or direct trauma to the eye area can create a pathway for infection.
• Foreign Bodies: Penetrating injuries that introduce bacteria into the orbital space can lead to cellulitis.

4. Dental Infections:

• Osteomyelitis or Dental Abscesses: Infections in the upper teeth or jaw can spread to the orbit, particularly in cases where the roots of the teeth are in close proximity to the orbital tissue.

5. Systemic Infections:

• Bacteremia: An infection that has spread from another site in the body can potentially lead to orbital cellulitis.
• Viral Infections: Certain viral infections, such as those caused by the herpes virus (e.g., herpes zoster ophthalmicus), may also contribute.

6. Pre-existing Conditions:

• Immunocompromised States: Individuals with weakened immune systems (due to conditions such as diabetes, HIV/AIDS, or cancer treatments) are at a higher risk for developing infections, including orbital cellulitis.

7. Other Factors:

• Congenital Conditions: Certain anatomical anomalies or conditions present at birth may predispose individuals to infections.
• Fungal Infections: In rare cases, especially in immunocompromised patients, fungal infections can cause orbital cellulitis.

Summary

Orbital cellulitis is often a complication of another medical condition or infection, notably sinusitis, and can arise from a variety of sources. Because of its significant potential for serious complications, including vision loss, prompt diagnosis and treatment are essential. If symptoms of orbital cellulitis are suspected, immediate medical evaluation is crucial.

How is the diagnosis of orbital cellulitis made?

The diagnosis of orbital cellulitis is made through a combination of clinical evaluation, patient history, and diagnostic imaging. Here are the key steps involved in diagnosing orbital cellulitis:

1. Clinical History:

• Symptoms: The healthcare provider will inquire about the onset and duration of symptoms, which may include eye pain, swelling, redness, vision changes, fever, and nasal symptoms.
• Pre-existing Conditions: A history of sinusitis, eye surgery, trauma, or dental issues may provide important context.

2. Physical Examination:

• Ocular Examination: The examination will focus on the eyes, orbita, and surrounding tissues. Key features include:
  • Swelling and erythema of the eyelids and periorbital area
  • Proptosis (bulging of the eye)
  • Limited eye movement or pain during movement
  • Changes in vision or diplopia (double vision)
• Systemic Signs: The provider will assess for fever, chills, or other systemic symptoms.

3. Diagnostic Imaging:

• CT Scan of the Orbits and Sinuses: A CT scan is often performed to assess the extent of the infection, its origin (often from the sinuses), and to rule out complications such as abscess formation. It is the gold standard for visualizing the soft tissues, orbital fat, and any adjacent structures.
• MRI: In certain cases, MRI might be used for a more detailed view, particularly if there are concerns about intracranial involvement or other soft tissue structures.

4. Laboratory Tests (if indicated):

• Blood Tests: Routine laboratory tests, such as a complete blood count (CBC), may be conducted to evaluate for elevated white blood cells (indicating infection) and other markers of inflammation.
• Cultures: If there is the presence of drainage or discharge (e.g., from an abscess), cultures may be taken to identify the causative organism, although this is not routinely performed at the initial diagnosis stage.

5. Differential Diagnosis:

• The healthcare provider will also consider and rule out other potential conditions that may mimic orbital cellulitis, such as:
  • Preseptal cellulitis (infection anterior to the orbital septum)
  • Orbital abscess
  • Intraocular infections
  • Thyroid eye disease

Conclusion

The diagnosis of orbital cellulitis is primarily clinical, supported by imaging studies to confirm the presence of infection and assess for complications. Prompt diagnosis is critical, as orbital cellulitis is a medical emergency that warrants immediate treatment to prevent serious complications such as vision loss or intracranial spread of infection.

What is the treatment for orbital cellulitis?

The treatment for orbital cellulitis typically involves a combination of intravenous antibiotics, supportive care, and, in some cases, surgical intervention. The specific approach depends on the severity of the infection, the underlying cause, and the patient’s overall health. Here’s an outline of the treatment options:

1. Antibiotic Therapy:

• Initial Empirical Therapy: Because the causative organisms are often bacteria that can vary based on the source of infection (such as sinusitis or skin), broad-spectrum intravenous antibiotics are usually initiated right away. Common choices include:
  • Vancomycin: To cover for methicillin-resistant Staphylococcus aureus (MRSA).
  • Ceftriaxone or Ampicillin/Sulbactam: For coverage against Streptococcus pneumoniae, Haemophilus influenzae, and anaerobic bacteria.
• Tailoring Therapy: Once culture results are available (if applicable), antibiotic therapy may be adjusted to target specific pathogens.

2. Supportive Care:

• Hydration: Ensuring the patient is well-hydrated can help support recovery.
• Analgesics: Pain management may involve the use of pain relievers to help control discomfort.

3. Surgical Intervention:

• Abscess Drainage: If imaging shows the presence of an abscess or if there is no improvement in clinical status despite appropriate antibiotic therapy, surgical drainage may be necessary.
• Sinus Surgery: If the orbital cellulitis is secondary to severe sinusitis, procedures like functional endoscopic sinus surgery (FESS) may be indicated to drain infected sinuses.

4. Monitoring:

• Patients with orbital cellulitis typically require close monitoring in a hospital setting, especially if they are showing signs of systemic infection, complications, or if their condition does not improve with initial treatment.

5. Follow-Up Care:

• After initial treatment, patients usually participate in follow-up care to assess for resolution of symptoms, ensure no residual infection, and manage any potential complications.

Conclusion:

Orbital cellulitis is a serious condition that requires immediate and aggressive treatment to prevent complications. The treatment plan is tailored to the individual patient based on clinical findings, response to therapy, and results from diagnostic imaging and cultures. Treatment often occurs in a hospital setting, especially for severe cases, to ensure prompt intervention and monitoring.