JAMA PATIENT PAGE Periorbital and Orbital Cellulitis

Periorbital cellulitis is an infection of the eyelid and area around the eye; orbital cellulitis is an infection of the eyeball and tissues around it. Periorbital and orbital cellulitis are infections that most often Periorbital and orbital cellulitis are infections that affect tissues occur in young children. The septum is a membrane that sepa- of the eye in front of and behind the orbital septum. rates the front part of the eye from the back part of the eye. Peri- Periorbital cellulitis affects the skin Orbital cellulitis affects deeper orbital cellulitis is also called preseptal cellulitis because it affects and soft tissue in front of the septum. tissues behind the septum. the structures in front of the septum, such as the eyelid and skin around the eye. Orbital cellulitis involves the eyeball itself, the fat around it, and the nerves that go to the eye. Both of these infec- tions can be caused by bacteria that normally live on the skin or by other bacteria.

Symptoms and Causes Orbital septum Orbital septum Periorbital cellulitis often occurs from a scratch or insect bite around Both infections can present with swelling, redness, fever, or pain, but have specific the eye that leads to infection of the skin. Symptoms can include characteristics that can be used to tell them apart along with imaging. swelling, redness, pain, and tenderness to touch occurring around Specific to periorbital cellulitis Specific to orbital cellulitis No pain with movement of eye Pain with movement of eye one eye only. The affected person is able to move the eye in all di- Vision is normal Double vision or blurry vision rections without pain, but there can be difficulty opening the eye- Proptosis (bulging of the eye) lid, often due to swelling. Vision is normal. Orbital cellulitis can occur as a complication of a sinus infec- tion; from trauma to the eye itself; from infection of the tear duct, teeth, ear, or face; or from spread of periorbital cellulitis. It may become an abscess (a pocket of pus) behind or around the eye or in the bone. Symptoms of orbital cellulitis include swelling, redness, pain, and tenderness to touch around one eye, although frequent examinations to evaluate the progress of the infection while these may be less obvious than in periorbital cellulitis. There is sig- being treated. nificant pain with movement of the eyeball. Double vision or blurry vision often occurs, and the eyeball might be bulging forward, a sign Considerations called proptosis. Because the eye is connected to the brain through the nerve be- hind it, orbital cellulitis can progress to a dangerous infection that can lead to a brain abscess, vision loss, or, very rarely, death. Testing for Periorbital and Orbital Cellulitis A doctor is needed to distinguish periorbital and orbital celluli- Prompt evaluation by a doctor, including history and physical ex- tis from other, more benign conditions, such as allergic reactions and amination, is very important to distinguish between the 2 types of viral or bacterial conjunctivitis, which often include the symptom of infection. Sometimes, blood tests can be done and may show signs red, swollen eyes. of infection. If there is a high suspicion of orbital cellulitis, an imaging scan, such as computed tomography (CT) with an intravenous dye, may be performed. A CT scan often requires sedation or anesthe- FOR MORE INFORMATION sia in young children. If there is concern for orbital cellulitis, an oph- • National Library of Medicine (periorbital cellulitis) thalmologist (eye doctor) should examine the patient. https://medlineplus.gov/ency/article/000976.htm • National Library of Medicine (orbital cellulitis) Treatment https://medlineplus.gov/ency/article/001012.htm Although both types of infection can be treated with intravenous antibiotics, orbital cellulitis is more dangerous and can result in in- A JAMA Patient Page on conjunctivitis was published in the May jury to the eye, and it may require surgery. Most often, children are 22, 2013, issue of JAMA. admitted to the hospital to receive intravenous antibiotics and have

Authors: Ioana Baiu, MD, MPH; Elliot Melendez, MD The JAMA Patient Page is a public service of JAMA. The information and Author Affiliations: Stanford Hospital, Stanford, California (Baiu); Pediatric Critical recommendations appearing on this page are appropriate in most instances, but they Care, Johns Hopkins All Children’s Hospital, St Petersburg, Florida (Melendez). are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page Conflict of Interest Disclosures: None reported. may be photocopied noncommercially by physicians and other health care Source: Hauser A, Fogarasi S. Periorbital and orbital cellulitis. Pediatr Rev. 2010;31(6): professionals to share with patients. To purchase bulk reprints, email reprints@ 242-249. doi:10.1542/pir.31-6-242 jamanetwork.com.

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