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
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
Risk factors
- sinusitis
- young age
- male sex
- lack of Hib vaccine in children
Diagnostic investigations
1st investigations to order
- clinical exam
- CT sinus and orbits with contrast medium
- WBC count
Investigations to consider
- blood culture
- microbiology swabs (conjunctiva, nasopharnyx, external wounds)
- MRI head and orbits with contrast medium
- lumbar puncture
Treatment algorithm
periorbital cellulitis: causative organism not identified
periorbital cellulitis: causative organism identified
orbital cellulitis: causative organism not identified
orbital cellulitis: causative organism identified
Contributors
Authors
H. Jane Kim, MD
Oculofacial Plastic and Reconstructive Surgery
Department of Ophthalmology
Kaiser Permanente Medical Group
Union City
CA
Disclosures
HJK declares that she has no competing interests.
Robert Kersten, MD
Professor of Clinical Ophthalmology
Department of Ophthalmology
University of California San Francisco
San Francisco
CA
Disclosures
RK declares that he has no competing interests.
Acknowledgements
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.
Peer reviewers
David M. Ozog, MD
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.
I-Hui (Elaine) Wu, MD
Resident
Wilmer Eye Institute
Baltimore
MD
Disclosures
IW declares that she has no competing interests.
Cristine Radojicic, MD
Staff Physician
Cleveland Clinic
Cleveland
OH
Disclosures
CR declares that she has no competing interests.
Jonathan Smith, MD
Specialist Registrar in Ophthalmology
Royal Victoria Infirmary
Newcastle
UK
Disclosures
JS declares that he has no competing interests.
Differentials
- Orbital pseudotumor (idiopathic orbital inflammation)
- Thyroid eye disease
- Panophthalmitis
More DifferentialsPatient leaflets
Cellulitis and erysipelas
Sinusitis
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