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Orbital cellulitis - Causes, Symptoms and Treatments
Orbital cellulitis is an acute infection of the orbital tissues and eyelids that doesn't involve the eyeball. With treatment, the prognosis is good; if cellulitis is not treated, however, infection may spread to the cavernous sinus or the meninges, where it can be life-threatening. Orbital cellulitis in young children is spread from adjacent sinuses (especially the ethmoid air cell) and accounts for the majority of postseptal cellulitis cases. Immunosuppressed patients and people with poor dental hygiene are also at risk.
Causes of Orbital cellulitis:
Orbital cellulitis may result from bacterial, fungal, or parasitic infections. The most common bacterial pathogens in children are Haemophilus infiuenzae, Streptococcus pneumoniae, and Staphylococcus aureus. The organisms invade the 0rbit, frequently by direct extension through the sinuses, the bloodstream, or the lymphatic ducts. The periorbital tissues may be inoculated as a result of surgery, foreign body trauma, or animal or insect bites.
Signs and symptoms of Orbital cellulitis:
Orbital cellulitis generally produces unilateral eyelid edema, hyperemia of the orbital tissues, reddened eyelids, and matted lashes. Although the eyeball is initially unaffected, proptosis develops later due to edematous tissues within the bony confines of the orbit. Other indications include extreme orbital pain, impaired eye movement, chemosis, and purulent discharge from indurated areas. The severity of associated systemic symptoms (chills, fever, and malaise) varies with the cause.
Complications include posterior extension, causing cavernous sinus thrombosis, meningitis, or brain abscess and, rarely, atrophy and subsequent loss of vision secondary to optic neuritis.
Diagnosis for Orbital cellulitis:
Typical clinical features establish the diagnosis. Wound culture and sensitivity testing determines the causative organism and specific antibiotic therapy. Other tests include white blood cell count, ophthalmologic examination, and a computed tomography (CT) scan of orbit tissues. A CT scan will rule out cellulitis due to preseptal or deeper structural causes, and will determine if a tumor is the cause of the swelling.
Treatment of Orbital cellulitis:
Prompt treatment is necessary to prevent complications. Primary treatment consists of antibiotic therapy. Systemic antibiotics (I.V. or oral) and eyedrops or ointment will be ordered. Supportive therapy consists of fluids; warm, moist compresses; and bed rest. The patient should be followed closely. If there's no improvement during the first 48 to 72 hours of treatment, antibiotic adjustment guided by drug sensitivity should be considered. An orbital abscess may necessitate surgical incision and drainage.
Special considerations and Prevention tips of Orbital cellulitis:
- Monitor vital signs, assess visual acuity, and maintain fluid and electrolyte balance.
- Have the patient instill antibiotic eyedrops during the day and use antibiotic ointment at night as prescribed.
- Apply compresses every 3 to 4 hours to localize inflammation and relieve discomfort. Teach the patient to apply these compresses. Give pain medication, as ordered, after assessing pain level.
- Before discharge, stress the importance of completing the prescribed antibiotic therapy.
To prevent orbital cellulitis, tell the patient to maintain good general hygiene and to carefully clean abrasions and cuts that occur near the orbit. Urge early treatment of orbital cellulitis to prevent infection from spreading.
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