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Periorbital and orbital cellulitis

Last reviewed: 5 Apr 2025
Last updated: 17 Sep 2024

Summary

Definition

History and exam

Key diagnostic factors

  • recent sinus infection
  • recent eyelid injury
  • redness and swelling of eye
  • ocular pain
  • decreased vision
  • proptosis
  • eyelid edema
  • insect bite on eyelid
  • stye or chalazion
  • ear or facial infection
  • ophthalmoplegia and diplopia
Full details

Other diagnostic factors

  • orbital trauma
  • skin infection
  • chemosis
  • tenderness around eye
  • fever
  • eyelid erythema
  • elevated intraocular pressure
  • headache
  • malaise
  • previous dental infection or dental work
  • orbital fracture
  • foreign body in eye or orbit
  • drowsiness
  • nausea/vomiting
  • nasal discharge
Full details

Risk factors

  • sinusitis
  • young age
  • male sex
  • lack of Hib vaccine in children
Full details

Diagnostic tests

1st tests to order

  • clinical exam
  • CT sinus and orbits with contrast medium
  • WBC count
Full details

Tests to consider

  • blood culture
  • microbiology swabs (conjunctiva, nasopharnyx, external wounds)
  • MRI head and orbits with contrast medium
  • Orbital ultrasonography
  • lumbar puncture
Full details

Treatment algorithm

ACUTE

periorbital cellulitis: causative organism not identified

periorbital cellulitis: causative organism identified

orbital cellulitis: causative organism not identified

orbital cellulitis: causative organism identified

Contributors

Authors

Oculoplastics Fellow

Moran Eye Center

University of Utah

Salt Lake City

UT

Disclosures

SS declares that he has no competing interests.

Professor of Clinical Ophthalmology

Division Chief, Oculoplastics

Moran Eye Center

University of Utah

Salt Lake City

UT

Disclosures

RK declares that he has no competing interests.

Dr Sudarshan Srivatsan and Dr Robert Kersten would like to gratefully acknowledge Dr Sandra Lora Cremers, Dr Sarosh Janjua, and Dr H. Jane Kim, previous contributors to this topic. SLC, SJ and HJK declare that they have no competing interests.

Peer reviewers

Director of Cosmetic Dermatology

Department of Dermatology

Cosmetic and Procedural Dermatology

Henry Ford Health System

Detroit

MI

Disclosures

DMO declares that he has no competing interests.

Resident

Wilmer Eye Institute

Baltimore

MD

Disclosures

IW declares that she has no competing interests.

Staff Physician

Cleveland Clinic

Cleveland

OH

Disclosures

CR declares that she has no competing interests.

Specialist Registrar in Ophthalmology

Royal Victoria Infirmary

Newcastle

UK

Disclosures

JS declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Robinson A, Beech T, McDermott AL, et al. Investigation and management of adult periorbital or orbital cellulitis. J Laryngol Otol. 2007;121:545-7. Abstract

Chandler JR, Langenbrunner DJ, Stevens ER. The pathogenesis of orbital complications in acute sinusitis. Laryngoscope. 1970;80:1414-1428. Abstract

Hamed-Azzam S, AlHashash I, Briscoe D, et al. Common orbital infections ~ state of the art ~ Part I. J Ophthalmic Vis Res. 2018 Apr-Jun;13(2):175-82.Full text  Abstract

American Academy of Ophthalmology. Orbital cellulitis​. Apr 2024 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Periorbital and orbital cellulitis images
  • Differentials

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  • Guidelines

    • Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)
    • Appropriateness criteria: orbital imaging and visual loss - child
    More Guidelines
  • Patient information

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    Sinusitis

    More Patient information
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