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Periorbital and orbital cellulitis

Last reviewed: 6 Nov 2023
Last updated: 27 Oct 2020

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
More key diagnostic factors

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
Other diagnostic factors

Risk factors

  • sinusitis
  • young age
  • male sex
  • lack of Hib vaccine in children
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical exam
  • CT sinus and orbits with contrast medium
  • WBC count
More 1st investigations to order

Investigations to consider

  • blood culture
  • microbiology swabs (conjunctiva, nasopharnyx, external wounds)
  • MRI head and orbits with contrast medium
  • lumbar puncture
More investigations to consider

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

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.

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