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Orbital Cellulitis

By James Garrity, MD

Orbital cellulitis is infection affecting the tissue within the orbit and around and behind the eye.

  • Infection can spread to the orbit from sources such as the sinuses around the nose.

  • Symptoms include pain, swelling, red eye, fever, a bulging eye, impaired vision, and impaired eye movements.

  • Usually, computed tomography or magnetic resonance imaging of the orbits is done.

  • Antibiotics are given by vein and the person is admitted to the hospital.

Both orbital cellulitis and preseptal cellulitis are more common among children. Preseptal cellulitis is far more common than orbital cellulitis. However, orbital cellulitis is more dangerous.

Orbital cellulitis usually is caused by spread of an infection to the orbit from the sinuses around the nose (nasal sinuses) but can also be spread from infection of the teeth or bloodstream. An animal or insect bite or another wound to the eyelids can also spread infection and lead to orbital cellulitis.

Without adequate treatment, orbital cellulitis can lead to blindness as well as to severe illness. Infection can spread to the brain ( meningitis) and spinal cord, or blood clots can form and spread from the veins around the eye to involve a large vein at the base of the brain (the cavernous sinus) and result in a serious disorder called cavernous sinus thrombosis.


Symptoms include pain, a bulging eye ( proptosis), red eye, reduced eye movement, double vision, pain with eye movement, swollen eyelids, and fever. Vision may be impaired.


  • Doctor's evaluation

  • Computed tomography or magnetic resonance imaging

  • Cultures of blood and samples from nasal sinus

Doctors can usually recognize orbital cellulitis without diagnostic tests. However, computed tomography (CT) or magnetic resonance imaging (MRI) usually is done to confirm the diagnosis. Also, determining the cause may require further assessment, including examination of the teeth and mouth and CT or MRI of the nasal sinuses. Often, doctors obtain samples from the nasal sinuses as well as blood samples and send them to a laboratory for testing. The samples are cultured (to grow microorganisms) to determine what bacteria are causing the infection, which areas are infected, and which antibiotic should be used. A person with orbital cellulitis is examined by an ophthalmologist (a medical doctor who specializes in eye disorders).


  • Admission to the hospital

  • Antibiotics

  • Surgery

People with orbital cellulitis are typically admitted to the hospital. Antibiotics are started as soon as possible, before the results of the laboratory testing are known. Antibiotics are given by vein. The antibiotic used at first may be changed if the culture results suggest that another antibiotic would be more effective. Sometimes surgery is needed if vision is impaired, to drain a collection of pus (abscess) or an infected nasal sinus, to remove a foreign body, or to help treat the infection if antibiotics alone are not effective.

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