Orbital Cellulitis Treatment & Management

  • Author: John N Harrington, MD, FACS; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 9, 2012
 

Medical Care

The patient with orbital cellulitis should be promptly hospitalized for treatment. Hospitalization should be continued until the patient is afebrile and is clearly improved clinically. Historically, the presence of subperiosteal or intraorbital abscess was an indication for surgical drainage in addition to antibiotic therapy; however, medical management alone is successful in many cases.[16, 17] Medical care of orbital cellulitis consists of the proper use of the appropriate antibiotics. Intravenous broad-spectrum antibiotics should be started immediately until the choice of antibiotics can be tailored for specifically identified pathogens identified on cultures. Typically, intravenous antibiotic therapy should be continued for 1-2 weeks and then followed by oral antibiotics for an additional 2-3 weeks. Fungal infection requires intravenous antifungal therapy along with surgical debridement.

Regarding pediatric care, Emmett et al found that the length of intravenous therapy associated with successful nonsurgical management of children selected for the study with subperiosteal abscess is considerably shorter than what is normally recommended in pediatric infectious disease literature, suggesting that clinical judgment, as regards each patient’s initial CT findings and evolving signs, symptoms, and laboratory profile, should be taken into account when scheduling intravenous intervals.[18]

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Surgical Care

Consider surgical drainage if the response to appropriate antibiotic therapy is poor within 48-72 hours or if the CT scan shows the sinuses to be completely opacified. If the presence of a drainable fluid collection is evident on CT scan, surgical drainage should be considered in patients older than 16 years. Consider orbital surgery, with or without sinusotomy, in every case of subperiosteal or intraorbital abscess formation, leaving the drains in place for several days. In cases of fungal infection, surgical debridement of the orbit is indicated and may require exenteration of the orbit and the sinuses. Canthotomy and cantholysis should be performed on an emergency basis if an orbital compartment syndrome is diagnosed at any point in the course of the disease.

Surgical drainage of an orbital abscess is indicated if any of the following occurs:

  • A decrease in vision occurs.
  • An afferent pupillary defect develops.
  • Proptosis progresses despite appropriate antibiotic therapy.
  • The size of the abscess does not reduce on CT scan within 48-72 hours after appropriate antibiotics have been administered. If brain abscesses develop and do not respond to antibiotic therapy, craniotomy is indicated.
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Consultations

Consult other specialties as indicated.

Generally, obtain consultation with a pediatrician, an internist, or a family physician, as well as an infectious disease specialist, in any case of orbital cellulitis.

Ear, nose, and throat (ENT) consultation is appropriate for cases of orbital cellulitis arising from sinus disease.

Neurosurgical consultation is indicated if brain abscesses appear.

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Diet

No special diet requirements are indicated other than adequate hydration of the patient.

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Activity

Hospitalization with intravenous antibiotic therapy is indicated.

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Contributor Information and Disclosures
Author

John N Harrington, MD, FACS  Director of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, Baylor University Medical Center; Clinical Professor Emeritus, Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, Southwestern Medical School

John N Harrington, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, and Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Brian A Phillpotts, MD  Former Vitreo-Retinal Service Director, Former Program Director, Clinical Assistant Professor, Department of Ophthalmology, Howard University College of Medicine

Brian A Phillpotts, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Medical Association, and National Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Mark T Duffy, MD, PhD  Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic

Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience

Disclosure: Allergan - Botox Cosmetic Honoraria Speaking and teaching

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

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A male patient with orbital cellulitis with proptosis, ophthalmoplegia, and edema and erythema of the eyelids. The patient also exhibited pain on eye movement, fever, headache, and malaise.
A male patient with orbital cellulitis with proptosis, ophthalmoplegia, and edema and erythema of the eyelids. The patient also exhibited chemosis and resistance to retropulsion of the globe.
 
 
 
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