Introduction  

Cellulitis of the eye is a bacterial infection that involves the skin and tissues around the eye. 
Orbital cellulitis affects the cheeks, eyelids and eyebrows. Orbital cellulitis can begin suddenly or result from an infection. It is more serious than preseptal cellulitis requiring urgent and more aggressive treatment. However, preseptal cellulitis is far more common than orbital cellulitis. 
Cellulitis that affects the eye can lead to loss of vision or even spread throughout the body.

Sub-Types

  • Preseptal or Periorbital - It usually occurs in children and affects the eyelid tissues in the front part of the eye.
  • Orbital - Orbital cellulitis affects the orbit (socket of the eye) or tissues around the orbit. 

Causes and Risk Factors

A bacterial or fungal infection causes cellulitis. The bacteria responsible for cellulitis include Staphylococcus aureus, Streptococcus pyogenes, beta-hemolytic streptococci and Haemophilus influenzae. Cellulitis can also arise from an insect bite, a wound on the skin, sinus infection, asthma and dental surgery. Inflammation on the conjunctiva and a stye can cause preseptal cellulitis. 
An infection can start in the sinuses before spreading to the eyelid and orbit. Bacteria may enter the body through direct trauma to the eye. It may also find its way in through sinuses, the cavities located near the nasal passage. An infection in the teeth and bloodstream can spread the disease too. Cellulitis frequently occurs in cold weather. 
Children, especially younger children are most at risk of getting cellulitis of the eye.

Signs & Symptoms

Symptoms of cellulitis may include:

  • Swelling of eyelid or tissue around the eye 
  • Swelling of the upper and lower eyelid
  • Fever
  • Proptosis (a bulging eye)
  • Red eyelids
  • Double or blurry vision
  • Problems moving the eye
  • Feelings of weakness
  • Pain with eye movement
  • The skin in the area of the eye feels warm
     

Diagnosis

The eye care professional will take a complete medical history of the individual. He/she will seek to establish whether the individual has had recent dental surgery. The professional will want to know about recent skin and face wounds. He/she may want to determine if there are any chest, lung or sinus infections. The following may be performed:

  • A complete blood count 
  • Blood test or culture if the professional suspects orbital cellulitis
  • A spinal tap in very sick children
  • Test of sample tissue from the eye or nose if the professional suspects preseptal cellulitis
  • Scan and/or magnetic resonance imaging (MRI) of the sinuses and orbit
  • Examination of teeth and mouth in case of orbital cellulitis 
  • Throat culture
     

Treatment 

Treatment of cellulitis that affects the eye is directed towards clearing the bacterial infection.

Medical Treatment

Antibiotics will be prescribed to treat cellulitis that affect the eye.  Examples of antibiotics that can be prescribed include Amoxicillin and Clavulanate. 
Hospitalization may be required for patients with orbital cellulitis since the condition may not improve with antibiotics (oral). The eye doctor may continuously give the patient special intravenous antibiotics.

Surgical Treatment

If there is a need to drain fluid from the infected area (abscess), the surgeon may perform a minor surgical procedure. Surgery may also be done due to an infected nasal sinus or to remove a foreign body. He/she may conduct it in the office or admit the patient in hospital.

Prognosis/Long-term outlook

If there is a need to drain fluid from the infected area (abscess), the surgeon may perform a minor surgical procedure. Surgery may also be done due to an infected nasal sinus or to remove a foreign body. He/she may conduct it in the office or admit the patient in hospital.

Prevention/Follow Up

An individual can do the following to prevent cellulitis of the eye:

  • Take a scheduled HiB vaccination
  • Young children exposed to a person with cellulitis should take antibiotics to avoid infection 
  • Prompt treatment of a sinus or dental infection 
  • Clean any wounds carefully
  • Carefully follow the dentist's instructions for after-surgery care