Orbital cellulitis is an infection of the tissues behind the orbital septum, around the eye muscles and fat. It usually spreads from the sinuses and is an emergency because it can threaten vision and reach the brain.
Key symptoms
- Red, swollen eyelids
- Pain with eye movement
- Double vision or blurred vision
- Fever and recent sinusitis
What you find on exam
- Bulging eye (proptosis)
- Limited and painful eye movements
- Reduced vision or color vision, or an afferent pupillary defect
- Preseptal cellulitis has lid swelling but normal eye movements and vision
Tests
- CT of the orbits and sinuses with contrast
- Blood count and blood cultures
- Imaging also looks for an abscess
Treatment basics
- IV antibiotics such as vancomycin with ceftriaxone
- Add metronidazole if spread inside the skull is a concern
- Urgent ophthalmology and ENT review
- Surgical drainage of an abscess
Red flags
- Falling vision or an afferent pupillary defect
- Headache, confusion or eye signs on both sides (cavernous sinus thrombosis)
- No improvement after 24 to 48 hours of antibiotics
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.