Infections may involve the tissues around or within the eye. These infections are most common among children.

Preseptal cellulitis

Preseptal cellulitis (periorbital cellulitis) is infection of the eyelid and skin and tissues around the front of the eye.

Preseptal cellulitis usually is caused by spread of an infection of the face or eyelid, an infected insect or animal bite, conjunctivitis, chalazion, or sinusitis.

Tissues around the eye become swollen, warm, tender, and usually red. Sometimes the eye is so swollen that it cannot be easily opened, but once opened, vision is not impaired. A fever may develop.

Doctors can often diagnose preseptal cellulitis by the person's symptoms, but sometimes orbital cellulitis may also be a possible diagnosis. If so, computed tomography (CT) or magnetic resonance imaging (MRI) is done.

Treatment consists of antibiotics (for example, amoxicillinSome Trade Names
AMOXIL TRIMOX
with clavulanate). If people are very ill or cannot take pills, hospitalization is recommended. People should be monitored closely by an ophthalmologist.

Orbital Cellulitis

Orbital cellulitis (postseptal 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.
• Pain, swelling, red eye, impaired vision, and impaired eye movements can develop.
• Usually, CT or MRI is done.
• Antibiotics are given by vein, and the person is admitted to the hospital.

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

Without adequate treatment, orbital cellulitis can lead to blindness. Infection can spread to the brain 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

Symptoms include pain, a bulging eye, red eye, reduced eye movement, double vision, swollen eyelids, and fever. The eyeball is swollen. Vision may be impaired.

What Is Cavernous Sinus Thrombosis?
The cavernous sinus is a large vein at the base of the brain, behind the eyes. The cavernous sinus is not one of the sinuses around the nose (the nasal sinuses). Cavernous sinus thrombosis is a very rare disorder in which this large vein becomes blocked by an infected blood clot. Cavernous sinus thrombosis is usually caused by the spread of bacteria from a nasal sinus infection or from an infection in the eye or around the nose. Thus, infections in the area around the nose to the rim of the eyes are always considered serious. Cavernous sinus thrombosis causes symptoms such as bulging eyes, severe headache or facial pain, impaired eye movements, double vision, loss of vision, drowsiness or coma, seizures, a high fever, and excessively dilated or uneven pupils. If bacteria spread to the brain, sleepiness, seizures, and abnormal sensations or muscle weakness in certain areas may develop. Computed tomography (CT) or magnetic resonance imaging (MRI) of the nasal sinuses, eyes, and brain is usually performed. To identify the bacteria, a blood sample and samples of fluid, mucus, or pus from the throat and nose are sent to a laboratory to be cultured. High doses of antibiotics given by vein are started immediately. If the condition does not improve after 24 hours of antibiotic treatment, the infected nasal sinus may be drained surgically.

Diagnosis

Doctors can usually recognize orbital cellulitis without diagnostic tests. However, CT or 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 organisms) to determine what organism is causing the infection, which areas are infected, and which antibiotic should be used. A person with orbital cellulitis is examined by an ophthalmologist.

Treatment

People are admitted to the hospital. Antibiotics are started as soon as possible, before the results of the laboratory testing are known. Antibiotics are usually given by vein initially. A few days later, once people recover, antibiotics are given by mouth. The antibiotic used at first may be changed if the culture results suggest that another antibiotic would be more effective. Sometimes surgery is needed to drain a collection of pus (abscess) or an infected nasal sinus, to correct impaired vision, to remove a foreign body or pus, or to treat the infection if antibiotics are not effective.

Last full review/revision September 2008 by James Garrity, MD