Orbital Cellulitis

Orbital Cellulitis

Orbital cellulitis, also known as cellulitis of the eye or post-septal cellulitis, is a bacterial infection that affects the dermal layer of the skin and the soft tissues surrounding the eye. Thus the eyelids, the eyebrow region and the cheek may be affected as well.

This condition causes pain, redness, and swelling in the orbital region; it may also lead to serious complications due to the proximity of the eye and brain structures.

Before antibiotic medications were found, this type of skin condition resulted in blindness in 20 percent of affected individuals, while death occurred in 17 percent. Therefore, this condition should be treated as a medical emergency and not ignored.

Treatment of this infection with antibiotic medications has significantly reduced the incidence of blindness and sepsis due to the spread of infection.


Symptoms and Signs

An individual with cellulitis of the eye may experience localized symptoms and systemic or general symptoms.

Localized symptoms are those occurring at the location of the infection, such as pain and bulging of the eye on the affected side; eye movements are limited as well; associated inflammatory signs such as swelling of the eyelids and surface membranes, a red or purple appearance to the eyelids are present. A decreased vision and/or double vision will result.

Systemic symptoms of orbital cellulitis include a mid-range or high fever, fatigue and discomfort.


Causes of Orbital Cellulitis

This infection may be caused by various types of bacteria. Most cases in adults are caused by Staphylococcus and Streptococcus strains of bacteria.

In infants and children under five years old, a bacterium called Haemophilus influenzae type b (Hib) has historically been associated to orbital cellulitis.

Nowadays, the introduction of Hib vaccine has dramatically decreased the number of orbital cellulitis due to Hib bacteria.


Risk Factors

Research indicates that there are certain factors that make a person more susceptible to developing orbital cellulitis. These risk factors for cellulitis of the eye include infections affecting the teeth, face or ear, trauma to the eye and sinus infections.

Chronic infections are more likely to lead to this type of medical condition than acute infections that are cleared up with antibiotic treatment.

Approximately 3 percent of people with chronic sinusitis will develop orbital cellulitis, and almost three-quarters of people with this condition have a comorbid sinus infection.



Orbital cellulitis is usually diagnosed by an eye doctor who will perform a clinical examination of the eye and visual testing as well. A thorough medical history of the patient and blood testing will help to assess the presence of an infection.

In some cases, medical imaging may be used to see the extent of the infection and whether an active sinus infection or an abscess is also present in addition to orbital cellulitis.



It is extremely important to get medical attention for orbital cellulitis immediately; the sooner orbital cellulitis is treated, the better complications can be prevented.

The first step in the treatment of this infection is a course of antibiotics. Hospital admission and intravenous administration of antibiotics are required in severe cases. More than one antibiotic medication may be used to clear up the infection.

After treatment for several days with intravenous antibiotics, oral antibiotic medications may be given. It is important to let your doctor know about any drug allergies, such as an allergy to penicillin or sulfa drugs, before undergoing antibiotic treatment.

Orbital cellulitis can also result in abscess formation and possibly the development of meningitis, a serious infection of the membranes around the brain and spinal cord. Meningitis is a life-threatening condition.

Other potential complications include permanent vision problems, like a residual limitation of eye movements on the affected side, double vision and even blindness.

Surgical intervention is sometimes indicated in cases where orbital infection led to the formation of an abscess, which needs to be drained. Surgery may also be an option if the antibiotic treatment is not working and if vision is endangered.

Untreated infections may spread to the bloodstream, causing septic shock and infection of internal organs. Thankfully, the prognosis with prompt medical intervention is good.

Image credit: DepositPhotos.com

Last article update: 9/13/2019

Medically reviewed by Dr. Thouria Bensaoula on Sept 13, 2019.