Orbital cellulitis - Wikipedia, the free encyclopedia

http://en.wikipedia.org/wiki/Orbital_cellulitis

Orbital cellulitis
From Wikipedia, the free encyclopedia

Orbital cellulitis is inflammation of eye tissues

behind the orbital septum. It most commonly refers to
an acute spread of infection into the eye socket from
either the adjacent sinuses or through the blood.
When it affects the rear of the eye, it is known as
retro-orbital cellulitis.
It should not be confused with periorbital cellulitis,
which refers to cellulitis anterior to the septum.

Orbital cellulitis

Classification and external resources

ICD-10

/classifications/icd10/browse

Contents

/2015/en#/H05.0)
ICD-9

1 Signs and symptoms

2 Causes

H05.0 (http://apps.who.int

376.01 (http://www.icd9data.com
/getICD9Code.ashx?icd9=376.01)

DiseasesDB 9249

3 Treatment

(http://www.diseasesdatabase.com

4 Prognosis

/ddb9249.htm)

5 Death and blindness rates without treatment

MedlinePlus 001012 (http://www.nlm.nih.gov

/medlineplus/ency/article

6 Complications
7 References
8 External links

/001012.htm)
eMedicine

article/1217858
(http://emedicine.medscape.com
/article/1217858-overview)

Signs and symptoms

MeSH

D054517 (https://www.nlm.nih.gov
/cgi/mesh/2015/MB_cgi?field=uid&
term=D054517)

Common signs and symptoms of orbital cellulitis

include pain with eye movement, sudden vision loss,
bulging of the infected eye, and limited eye movement. Along with these symptoms, patients typically
have redness and swelling of the eyelid, pain, discharge, inability to open the eye, occasional fever and
lethargy. It is usually caused by a previous sinusitis. Other causes include infection of nearby structures,
trauma and previous surgery.

Causes
Orbital cellulitis occurs commonly from bacterial infection spread via the paranasal sinuses. Other ways
in which orbital cellulitis may occur is from infection in the blood stream or from an eyelid skin
infection. Upper respiratory infection, sinusitis, trauma to the eye, ocular or periocular infection and

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systemic infection all increase ones risk of orbital cellulitis.

Staphylococcus aureus, Streptococcus pneumoniae and beta-hemolytic streptococci are three bacteria
that can be responsible for orbital cellulitis.
Staphylococcus aureus, is a gram-positive bacterium which is the most common cause of
staphylococcal infections. Staphylococcus aureus infection can spread to the orbit from the skin.
These organisms are able to produce toxins which promote their virulence which leads to the
inflammatory response seen in orbital cellulitis. Staphylococcus infections are identified by a
cluster arrangement on gram stain. Staphylococcus aureus forms large yellow colonies (which is
distinct from other Staph infections such as Staphylococcus epidermidis which forms white
colonies).
Streptococcus pneumoniae, is also a gram-positive bacterium responsible for orbital cellulitis due
to its ability to infect the sinuses (sinusitis). Streptococcal bacteria are able to determine their own
virulence and can invade surrounding tissues causing an inflammatory response seen in orbital
cellulitis (similar to Staphyloccoccus aureus). Streptococcal infections are identified on culture by
their formation of pairs or chains. Streptococcus pneumoniae produce green (alpha) hemolysis, or
partial reduction of red blood cell hemoglobin.

Treatment
Immediate treatment is very important for someone with orbital cellulitis. Treatment typically involves
intravenous (IV) antibiotics in the hospital and frequent observation (every 4-6 hours). Along with this
several laboratory tests are run including a complete blood count, differential, and blood culture.
Antibiotic Therapy - Since orbital cellulitis is commonly caused by Staphylococcus and
Streptococcus species both penicillins and cephalosporins are typically the best choices for IV
antibiotics. However, due to the increasing rise of MRSA (methicillin-resistant Staphylococcus
aureus) orbital cellulitis can also be treated with Vancomycin, Clindamycin, or Doxycycline. If
improvement is noted after 48 hours of IV antibiotics, healthcare professions can then consider
switching a patient to oral antibiotics (which must be used for 2-3 weeks).
Surgical Intervention - An abscess can threaten the vision or neurological status of a patient with
orbital cellulitis, therefore sometimes surgical intervention is necessary. Surgery typically requires
drainage of the sinuses and if a subperiosteal abscess is present in the medial orbit, drainage can
be performed endoscopically. Post-operatively, patients must follow up regularly with their
surgeon and remain under close observation.

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Prognosis
Although orbital cellulitis is considered an ophthalmic emergency the prognosis is good if prompt
medical treatment is received.

Death and blindness rates without treatment

Bacterial infections of the orbit have long been associated with a risk of catastrophic local sequelae and
intracranial spread.
The natural course of the disease, as documented by Gamble (1933), in the pre-antibiotic era, resulted in
death in 17% of patients and permanent blindness in 20%.

Complications
Complications include hearing loss, blood infection, meningitis, cavernous sinus thrombosis, and optic
nerve damage (which could lead to blindness).

References
Nageswaran, Savithri; Woods, Charles R.; Benjamin, Daniel K.; Givner, Laurence B.; Shetty,
Avinash K. (1 August 2006). "Orbital Cellulitis in Children". The Pediatric Infectious Disease
Journal 25 (8): 695699. doi:10.1097/01.inf.0000227820.36036.f1 (https://dx.doi.org
/10.1097%2F01.inf.0000227820.36036.f1). PMID 16874168 (https://www.ncbi.nlm.nih.gov
/pubmed/16874168).
Howe L, Jones N (2004). "Guidelines for the management of periorbital cellulitis/abscess". Clin
Otolaryngol Allied Sci 29 (6): 7258. doi:10.1111/j.1365-2273.2004.00889.x (https://dx.doi.org
/10.1111%2Fj.1365-2273.2004.00889.x). PMID 15533168 (https://www.ncbi.nlm.nih.gov/pubmed
/15533168).
Garcia GH, Harris GJ (2000). "Criteria for nonsurgical management of subperiosteal abscess of
the orbit: analysis of outcomes". Ophthalmology 107 (8). doi:10.1016/S0161-6420(00)00242-6
(https://dx.doi.org/10.1016%2FS0161-6420%2800%2900242-6).
Ferguson MP, McNabb AA (1999). "Current treatment and outcome in orbital cellulitis".
Australian and New Zealand Journal of Ophthalmology 27 (6): 375379.
doi:10.1046/j.1440-1606.1999.00242.x (https://dx.doi.org
/10.1046%2Fj.1440-1606.1999.00242.x). PMID 10641894 (https://www.ncbi.nlm.nih.gov
/pubmed/10641894).
Noel LP, Clarke WN, MacDonald N (1990). "Clinical management of orbital cellulitis in

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children". Canadian Journal of Ophthalmology 25 (1): 1116. PMID 2328431

(https://www.ncbi.nlm.nih.gov/pubmed/2328431).
Shapiro E, Wald E, Brozanski B (1982). "Periorbital cellulitis and paranasal sinusitis: a
reappraisal". Pediatric Infectious Disease 1 (2). doi:10.1097/00006454-198203000-00005
(https://dx.doi.org/10.1097%2F00006454-198203000-00005).

External links
University of Toronto (http://eyelearn.med.utoronto.ca/Lectures05-06/RedEye/05Orbit.htm)
MedlinePlus (http://www.nlm.nih.gov/medlineplus/ency/article/001012.htm).
Merck Manual (http://www.merck.com/mmpe/sec09/ch108/ch108d.html).
Handbook of Ocular Disease Management (http://www.revoptom.com/handbook/SECT7g.HTM).
Orbital Cellulitis Photos and Medical Notes Case Study and discussion of misdiagnosis by four
hospitals for the same patient (http://www.eyeinfectionphotos.com).
American Academy of Ophthamology (http://www.aao.org/theeyeshaveit/red-eye/orbitalcellulitis.cfm)
Death Rates for Orbital Cellulitis (http://www.springerlink.com/content/qq1x737u71588j31/)
Pub Med Health - Orbital Cellulitis (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002007/)
Retrieved from "http://en.wikipedia.org/w/index.php?title=Orbital_cellulitis&oldid=652761157"
Categories: Bacterial diseases Disorders of eyelid, lacrimal system and orbit
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