Orbital cellulitis
Orbital cellulitis is a localized infection. Preseptal cellulitis affects the lids which are anterior to the orbital septum. Orbital cellulitis affects the fat, muscle, and other soft tissues within the bony orbit which are posterior to the orbital septum.
CASES/YEAR
10,800 (US); 216,000 (Global)
OTHER NAMES
Preseptal cellulitis; Periorbital cellulitis (old term);
INCUBATION
Estimated: days (bacteria) to weeks (fungi);
INITIAL SYMPTOMS
Lids are red & may be swollen shut. Preseptal: normal pupils & visual acuity; eye movements full & painless; Orbital: pupillary defect; loss of vision; eye pain worse with movement; proptosis; [PPID, p. 1545]
COMMENTS
Preseptal cellulitis affects the lids which are anterior to the orbital septum. Orbital cellulitis affects the fat, muscle, and other soft tissues within the bony orbit which are posterior to the orbital septum. This bony orbit is surrounded by sinuses. Sinusitis, especially ethmoid sinusitis, causes 80-90% of all cases of preseptal and orbital cellulitis. Preseptal cellulitis is much more common than orbital cellulitis, and most patients with these infections are young children. In one series of patients, 70% of children and 30% of adults had fever. Cavernous sinus thrombophlebitis is a complication of orbital cellulitis. In a series of 159 patients with orbital complications of sinusitis, 4 became blind. CT is not needed in some cases of preseptal cellulitis. "Some authors advocate CT for all children with preseptal cellulitis, however, and report three cases of subperiosteal abscess that presented similar to preseptal cellulitis, with no proptosis, visual decrease, or ophthalmoplegia." [PPID, p. 1544-6]
Preseptal cellulitis is caused by contiguous spread of infection from the eyelid or face, while orbital cellulitis is usually caused by sinusitis and less often by spread from contiguous facial or eyelid infections. Findings may include nasal discharge and bleeding from sinuses. Meningitis is a complication. [Merck Manual, p. 951-2] Other findings are headache and mild leukocytosis. Consider rhinocerebral mucormycosis in patients with diabetic ketoacidosis. [ABX Guide]
DIAGNOSTIC
Close consultation with ophthalmology and/or ENT; Initial study is CT with contrast to distinguish preseptal from orbital; ; MRI for diagnosis of cavernous sinus thrombosis; Conjunctival cultures may help, but often contaminant growth; [ABX Guide]
SIGNS & SYMPTOMS
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>fever
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E epistaxis
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E rhinitis
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H leukocytosis
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N headache
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O conjunctivitis, acute
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*blindness
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*brain abscess or lesion
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*cranial neuropathy
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*meningitis
ENTRY
Inhalation, Skin or Mucous Membranes (Includes Conjunctiva)
REFERENCES FOR CASES/YEAR
1. (US) Incidence has decreased since Hib vaccine introduced in 1985; In 2000, incidence per 100,000 in California was 3.5 in whites, 6.1 in blacks and 3.2 in Hispanics; [5MCC-2015] Calculate: 3.6 x 3000 = 10,800 (US);
2. (Global) 10,800 x 20 = 216,000;