When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Periorbital and orbital cellulitis

Last reviewed: 10 Sep 2024
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

Sudarshan Srivatsan, MD

Oculoplastics Fellow

Moran Eye Center

University of Utah

Salt Lake City

UT

Disclosures

SS declares that he has no competing interests.

Robert Kersten, MD, FACS, FASOPRS

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.

Acknowledgements

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

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.

  • Periorbital and orbital cellulitis images
  • Differentials

    • Orbital pseudotumor (idiopathic orbital inflammation)
    • Thyroid eye disease
    • Panophthalmitis
    More Differentials
  • 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

    Cellulitis and erysipelas

    Sinusitis

    More Patient information
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer