Orbital Cellulitis

Fatma Asyari SpM(K)

Department of
Ophthalmology
 Anatomy of Orbital
Cavity

no wall of the orbit is immune to sinus

pathology.
very thin bony walls
perforated by small vessels and nerves
 The orbital septum
a layer of fascia extending vertically
from the periosteum of the orbital
rim to the levator aponeurosis in the
upper eyelid and to the inferior
border of the tarsal plate in the
lower eyelid.
 Preseptal / peri
orbital
Cellulitis
Infection anterior to orbital
septum
facial cellulitis , lid
no protrusion
full range of movement
good visual acuity
normal pupillary reactions
 Orbital Cellulitis

dangerous infection of the orbital soft tissues

with potentially serious complications

Infection of tissues behind the orbital septum

by direct inoculation from accidental trauma
or surgery, or hematogenous spread of
infection.

Involving orbital structures

Usually secondary to ethmoiditis ( 90 %)

 Orbital Cellulitis
Most common causative agents :

- Staphylococcus aureus
- Streptococcus pyogenes
- Haemophillus influenzae
- Anaerobic micro-organisms

Fungal orbital cellulitis (Mucor and

Aspergillus )
is potentially lethal
 Orbital Cellulitis
Presentation :

- severe malaise, fever

- severe eyelid oedema , chemosis and
redness
- proptosis - most frequently lateral and down
- limitations of movement
- painful ophthalmoplegia
- optic nerve dysfunction if advanced
- loss of vision
- life threatening
 Lab Studies
A complete blood count
Obtain blood cultures prior to the
administration of any antibiotics
Collect purulent material from the nose sinuses
or directly from an orbital abscess for :
- Gram stain
- culture on both aerobic and anaerobic
media
Needle aspiration of the orbit is
contraindicated.
Lumbar puncture is advisable if cerebral or
meningeal signs develop.

 Imaging Studies

High-resolution CT scan
( to rule out peridural and
parenchymal brain , periorbital
abscess)

MRI may be helpful in defining orbital

abscesses and in evaluating the
possibility of cavernous sinus
disease.
Management of orbital
cellulitis

Hospital admission
Systemic antibiotic therapy
Monitoring of optic nerve
function
 Consider Surgery

Resistance to antibiotics (48 72 h )

Orbital or subperiosteal, brain abscess
decreased vision / optic neuropathy
Proptosis progresses despite appropriate
antibiotic therapy
abscess does not reduce on CT scan within
48-72 hours after appropriate antibiotics
If brain abscesses develop and do not
respond to antibiotic therapy
Consult other specialties as indicated.
 Key to successful
treatment
Prompt administration of appropriate antibiotics

Most cases of orbital cellulitis result from

ethmoid sinusitis
the initial antibiotics are chosen based on the
most likely sinus pathogens:
- Streptococcus pneumoniae
- other streptococci
- Staphylococcus aureus
- Haemophilus influenzae
- non- sporeforming anaerobes.
 Key to successful
treatment
.
Fungal orbital cellulitis also occurs and
primarily is due to Mucor and Aspergillus
species
antifungals are required

secondary glaucoma secondary to the

orbital cellulitis

post-traumatic orbital cellulitis, tetanus

prophylaxis should be given
 Complications of orbital
cellulitis
Raised intraocular pressure ( 2ry
glaucoma )
Retinal vasculature occlusion
Optic neuropathy
Orbital or sub-periosteal abscess
Meningitis, brain abscess
Bilateral : Cavernous sinus thrombosis
Optic
neuropathy

Retinal vasculature
occlusion
 Orbital or
subperiosteal
abscess
Meningitis, brain
abscess
Cavernous sinus
THANK YOU