Periorbital and Orbital Cellulitis

Periorbital cellulitis is an infection of the eyelid and area around the eye; orbital cellulitis is an infection of the eyeball and tissues around it.

Periorbital and orbital cellulitis are infections that most often occur in young children. The septum is a membrane that separates the front part of the eye from the back part of the eye. Periorbital cellulitis is also called preseptal cellulitis because it affects the structures in front of the septum, such as the eyelid and skin around the eye. Orbital cellulitis involves the eyeball itself, the fat around it, and the nerves that go to the eye. Both of these infections can be caused by bacteria that normally live on the skin or by other bacteria.

Periorbital cellulitis often occurs from a scratch or insect bite around the eye that leads to infection of the skin. Symptoms can include swelling, redness, pain, and tenderness to touch occurring around one eye only. The affected person is able to move the eye in all directions without pain, but there can be difficulty opening the eyelid, often due to swelling. Vision is normal.

Orbital cellulitis can occur as a complication of a sinus infection; from trauma to the eye itself; from infection of the tear duct, teeth, ear, or face; or from spread of periorbital cellulitis. It may become an abscess (a pocket of pus) behind or around the eye or in the bone. Symptoms of orbital cellulitis include swelling, redness, pain, and tenderness to touch around one eye, although these may be less obvious than in periorbital cellulitis. There is significant pain with movement of the eyeball. Double vision or blurry vision often occurs, and the eyeball might be bulging forward, a sign called proptosis.

Prompt evaluation by a doctor, including history and physical examination, is very important to distinguish between the 2 types of infection. Sometimes, blood tests can be done and may show signs of infection. If there is a high suspicion of orbital cellulitis, an imaging scan, such as computed tomography (CT) with an intravenous dye, may be performed. A CT scan often requires sedation or anesthesia in young children. If there is concern for orbital cellulitis, an ophthalmologist (eye doctor) should examine the patient.

Although both types of infection can be treated with intravenous antibiotics, orbital cellulitis is more dangerous and can result in injury to the eye, and it may require surgery. Most often, children are admitted to the hospital to receive intravenous antibiotics and have frequent examinations to evaluate the progress of the infection while being treated.

Because the eye is connected to the brain through the nerve behind it, orbital cellulitis can progress to a dangerous infection that can lead to a brain abscess, vision loss, or, very rarely, death.

A doctor is needed to distinguish periorbital and orbital cellulitis from other, more benign conditions, such as allergic reactions and viral or bacterial conjunctivitis, which often include the symptom of red, swollen eyes.

Conflict of Interest Disclosures: None reported.

Source: Hauser A, Fogarasi S. Periorbital and orbital cellulitis. Pediatr Rev. 2010;31(6):242-249. doi:10.1542/pir.31-6-242