Orbital Cellulitis Clinical Presentation

Updated: Jul 30, 2018
  • Author: John N Harrington, MD, FACS; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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Presentation

History

A thorough history and physical examination are critical in establishing a diagnosis of orbital cellulitis. Patients with orbital cellulitis frequently complain of fever, malaise, and a history of recent sinusitis or upper respiratory tract infection. Questioning the patient about any recent facial trauma or surgery, dental work, [15] or infection elsewhere in the body is important.

Diverse conditions such as sickle cell orbitopathy, bisphosphonate use, and cosmetic fillers can cause orbital inflammation that can be mistaken for infection.

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Physical Examination

Proptosis and ophthalmoplegia are the cardinal signs of orbital cellulitis. The symptoms and signs of orbital cellulitis can advance at an alarming rate and eventually lead to prostration. (See the images below.)

A male patient with orbital cellulitis with propto 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 who demonst A male patient with orbital cellulitis who demonstrated proptosis, ophthalmoplegia, and edema and erythema of the eyelids. The patient also exhibited chemosis and resistance to retropulsion of the globe.

Proptosis and ophthalmoplegia may be accompanied by the following:

  • Decreased vision, dyschromatopsia, and relative afferent pupillary defect

  • Elevated intraocular pressure

  • Pain on eye movement

  • Conjunctival chemosis

  • Orbital pain and tenderness - Are present early

  • Dark red discoloration of the eyelids, chemosis, hyperemia of the conjunctiva, and resistance to retropulsion of the globe may be present

  • Purulent nasal discharge may be present

Vision may be normal early, but it may become difficult to evaluate in very ill children with marked edema.

The above signs may be accompanied by the following:

  • Fever

  • Headache

  • Lid edema

  • Rhinorrhea

  • Increasing malaise

Methicillin-resistant Staphylococcus aureus (MRSA) should be considered in the setting of multiple orbital abscesses and lacrimal gland abscess.

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