Peri-orbital cellulitis is an infectious process occurring in the eyelid tissues superficial to (anterior to or above) the orbital septum. It is usually due to superficial tissue injury (e.g., insect bite or chalazion).
Orbital cellulitis is an infectious process affecting the muscles and fat within the orbit, posterior or deep to the orbital septum, not involving the globe. It is usually due to underlying bacterial sinusitis.
Peri-orbital cellulitis is of concern in children because it may be secondary to occult underlying bacterial sinusitis or, rarely, due to bacteraemic spread from a primary infection (e.g., pneumonia), and may rapidly progress to orbital cellulitis in children.
Complications include sub-periosteal abscess, cavernous sinus thrombosis, intracranial abscess, and subsequent loss of vision and/or death.
Peri-orbital (also known as pre-septal) cellulitis is inflammation and infection of the superficial eyelid, usually from a superficial source. The inflammation remains confined to the soft tissue layers superficial to the orbital septum and ocular function remains intact.
Orbital cellulitis is an infection within the orbital soft tissues with associated ocular dysfunction and is usually due to underlying bacterial sinusitis. Orbital cellulitis is a far more serious condition and warrants hospital admission. It has much higher morbidity than peri-orbital cellulitis, and warrants urgent imaging and surgical evaluation by oculoplastic as well as a head-and-neck consultant.
History and exam
Key diagnostic factors
- presence of risk factors
- recent sinus infection
- recent eyelid injury
- redness and swelling of eye
- ocular pain
- decreased vision
- eyelid oedema
- insect bite on eyelid
- stye or chalazion
- ear or facial infection
- ophthalmoplegia and diplopia
Other diagnostic factors
- orbital trauma
- skin infection
- tenderness around eye
- eyelid erythema
- elevated intra-ocular pressure
- previous dental infection or dental work
- orbital fracture
- foreign body in eye or orbit
- nasal discharge
- young age
- male sex
- lack of Hib vaccine in children
1st investigations to order
- clinical examination
- CT sinus and orbits with contrast medium
- WBC count
Investigations to consider
- blood culture
- microbiology swab (conjunctiva, nasopharynx, external wounds)
- MRI head and orbits with contrast medium
- lumbar puncture
peri-orbital cellulitis: causative organism not identified
peri-orbital cellulitis: causative organism identified
orbital cellulitis: causative organism not identified
orbital cellulitis: causative organism identified
H. Jane Kim, MD
Oculofacial Plastic and Reconstructive Surgery
Department of Ophthalmology
Kaiser Permanente Medical Group
HJK declares that she has no competing interests.
Robert Kersten, MD
Professor of Clinical Ophthalmology
Department of Ophthalmology
University of California San Francisco
RK declares that he has no competing interests.
Dr H. Jane Kim and Dr Robert Kersten would like to gratefully acknowledge Dr Sandra Lora Cremers and Dr Sarosh Janjua, previous contributors to this topic. SLC and SJ declare that they have no competing interests.
David M. Ozog, MD
Director of Cosmetic Dermatology
Department of Dermatology
Cosmetic and Procedural Dermatology
Henry Ford Health System
DMO declares that he has no competing interests.
I-Hui (Elaine) Wu, MD
Wilmer Eye Institute
IW declares that she has no competing interests.
Cristine Radojicic, MD
CR declares that she has no competing interests.
Jonathan Smith, MD
Specialist Registrar in Ophthalmology
Royal Victoria Infirmary
JS declares that he has no competing interests.
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