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