Orbital cellulitis refers to an acute infection of the soft tissues of the orbit behind the orbital septum. The infection can be exogenous (trauma, foreign body), endogenous (septicemia) or extension of infection from neighbouring structures (paranasal sinuses, teeth, face, eyelids).

Clinical features:

Ø  Common causes include Streptococcus pneumoniae, Staphylococcus aureus, Streptococcus pyogenes and Haemophilus influenzae.

Ø  Symptoms include swelling of eyelids, severe pain which is increased by movements of eye or pressure and fever, nausea, vomiting and sometimes loss of vision.

Ø  A marked swelling of lids with chemosis of conjunctiva is observed. Restriction of ocular movements is also seen.

Ø  Fundus examination may show congestion of retinal veins and signs of papillitis or papilloedema

Ø  Bacterial cultures should be performed from nasal and conjunctival swabs and blood samples, X-ray to identify associated sinusitis and orbital ultrasonography to detect intra- orbital abscess should be done.

Non- pharmacological treatment:

l  Warm compresses.

Pharmacological treatment:

1.  Intensive antibiotic therapy:

- After obtaining nasal, conjunctival and blood culture samples, intravenous higher broad spectrum antibiotics should be administered.

-  Tab. amoxicillin and clavulanic acid 625mg TDS should be given OR

-  Inj. cefotaxime 1-2 gm every 12 hours in adults and 100-150 mg/kg in 2 to 3 divided doses in children are given. Antibacterials are changed according to the culture sensitivity reports and continued till resolution of symptoms.

-  Ciprofloxacin or vancomycin may be used an alternative.

2.  Analgesic and anti-inflammatory drugs are helpful in controlling pain and fever.

3.  Surgical intervention is needed when the patient is unresponsive to antibacterials, decrease in vision and presence of an orbital or subperiosteal abscess.

Patient education:

u  Any ear, sinus or dental infection especially in children should be treated promptly

u  Any patient presenting with unexplained lid edema or cellulitis should be immediately referred to an ophthalmologist.