Orbital Cellulitis Workup

Updated: May 29, 2019
  • Author: John N Harrington, MD, FACS; Chief Editor: Edsel B Ing, MD, MPH, FRCSC, PhD, MA  more...
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Laboratory Studies

Laboratory evaluation should include the following (needle aspiration of the orbit is contraindicated):

  • Complete blood count (CBC) - Leukocytosis greater than 15,000 with a shift to the left commonly is seen.

  • Blood cultures - Obtain blood cultures prior to the administration of any antibiotics, although they are unlikely to reveal the responsible organism

  • Purulent material assessment - Collect purulent material from the nose with a cotton or calcium alginate swab, smear for Gram stain, and culture on aerobic and anaerobic media; assess any material obtained from the sinuses or directly from an orbital abscess in the same manner


Imaging Studies

High-resolution contrast CT scanning of the orbit with axial and coronal views is very helpful. Axial views should include low, narrow cuts of the frontal lobes to rule out peridural and parenchymal brain abscess formation. Coronal views are helpful in determining the presence and extent of any subperiorbital abscesses. Orbital fat stranding suggests orbital cellulitis. Globe tenting is an adverse prognostic sign, particularly in adults. [17]

MRI may be helpful in defining orbital abscesses and in evaluating the possibility of cavernous sinus disease.



Lumbar puncture is advisable if cerebral or meningeal signs develop.