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Clinical Summary

Orbital cellulitis is a serious bacterial infection involving the fat and muscle within the orbit characterized by fever, painful purple-red eyelid swelling, ophthalmoplegia, pain with extraocular movements, proptosis, and variable decreased visual acuity. It may begin with eye pain and fever. In general, it is caused by Streptococcus anginosus, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and S aureus. It usually arises as a complication of ethmoid or maxillary sinusitis. If not treated promptly, it can lead to blindness, cavernous venous sinus thrombosis, meningitis, subdural empyema, or brain abscess.

Preseptal (periorbital) cellulitis is much more common and involves the structures anterior to the orbital septum. It usually presents with edema and circumferential erythema of the eyelids and periorbital skin, fever, and minimal pain. Proptosis and ophthalmoplegia are not characteristic as it does not involve the orbit or other ocular structures. Preseptal cellulitis usually results from sinusitis or contiguous infection due to local skin trauma, insect bite, or hordeolum. Common organisms are S aureus and group A Streptococcus.

FIGURE 14.74

Orbital Cellulitis. Eye redness, swelling, purulent drainage, and mild entrapment are seen in this patient with painful orbital cellulitis. (Photo contributor: Kevin J. Knoop, MD, MS.)

FIGURE 14.75

Orbital Cellulitis. Right ethmoid sinus with subperiosteal abscess and extension into the orbital space seen in the patient in Figure 14.74. (Photo contributor: Kevin J. Knoop, MD, MS.)

FIGURE 14.76

Orbital Cellulitis. CT confirmed orbital cellulitis in this 2-month-old. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 14.77

Orbital Cellulitis. Left ethmoid sinusitis with extension into the orbital space, periosteal abscess formation, and proptosis is seen in this patient (A) and on CT (B). (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 14.78

Preseptal Cellulitis. Periorbital cellulitis with abscess formation seen in this patient (A) and on CT (B). (Photo contributor: Eftitan Akam, MD.)

FIGURE 14.79

Preseptal Cellulitis. Cellulitis originating from local skin trauma in the left eyebrow. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 14.80

Preseptal Cellulitis. Preseptal cellulitis extending from a hordeolum. (Photo contributor: David Effron, MD.)

Management and Disposition

Broad-spectrum IV antibiotics with methicillin-resistant staphylococcal coverage, ophthalmologic consultation, and admission are indicated in cases of ...

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