Orbital cellulitis is an acute infection of the orbital tissues and eyelids that doesn’t involve the eyeball. With treatment, the prognosis is good; if untreated, the infection may spread to the cavernous sinus or the meninges, where it can be life-threatening.
Orbital cellulitis may result from bacterial, fungal, or parasitic infection. It can develop from direct inoculation, via the bloodstream, or spread from adjacent structures. Periorbital tissues may be inoculated as a result of surgery, foreign body trauma, and even animal or insect bites. The most common pathogens in children are Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus. In young children, it’s spread from adjacent sinuses (especially the ethmoid air cells) and accounts for the majority of postseptal cellulitis cases. Immunosuppressed patients are also susceptible.
Orbital cellulitis generally produces unilateral eyelid edema, hyperemia of the orbital tissues, reddened eyelids, and matted lashes. Although the eyeball is initially unaffected, proptosis develops later (because of edematous tissues within the bony confines of the orbit). Other indications include extreme orbital pain, impaired eye movement, chemosis, and purulent discharge from indurated areas. The severity of associated systemic symptoms (chills, fever, and malaise) varies according to the cause.
Complications include posterior extension, causing cavernous sinus thrombosis, panophthalmitis, meningitis, or brain abscess and, rarely, atrophy and subsequent loss of vision secondary to optic neuritis.
Typical clinical features establish diagnosis. Computed tomography scan or magnetic resonance imaging of the sinuses and orbit tissues will determine if the cause of the cellulitis is preseptal or if deeper structures are involved, or if a tumor is the cause of swelling. Usually the patient will also be febrile with this type of infection. Wound culture and sensitivity testing determine the causative organism and specific antibiotic therapy. Other tests include white blood cell count, and ophthalmologic examination.
Prompt treatment is necessary to prevent complications. Primary treatment consists of antibiotic therapy. Systemic antibiotics (I.V. or oral) and eyedrops or ointment will be ordered. Supportive therapy consists of fluids; warm, moist compresses; and bed rest. The patient should be monitored closely. If during the initial 48 to 72 hours of treatment no improvement is seen, adjustment of antibiotics guided by drug sensitivity should be considered. If an orbital abscess is present, surgical incision and drainage may be necessary.
❑ Monitor vital signs at least every 4 hours, and maintain fluid and electrolyte balance.
❑ Have the patient instill antibiotic eyedrops frequently during the day and apply ointment at night.
❑ Apply compresses every 3 to 4 hours to localize inflammation and relieve discomfort. Teach the patient to apply these compresses. Give pain medication, as ordered, after assessing pain level.
❑ Before discharge, stress the importance of completing prescribed antibiotic therapy. To prevent orbital cellulitis, tell the patient to maintain good general hygiene and to carefully clean abrasions and cuts that occur near the orbit.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X 
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