Causes and Risks:
Orbital cellulitis is a dangerous infection with potentially serious complications. It is usually caused by a bacterial infection which typically will have spread from the ethmoid or para-nasal sinuses but may also have its origin elsewhere such as a boil on the eye or eyelid, recent trauma to the eye, or a foreign object. In children, orbital cellulitis, and the less serious infection but still important periorbital cellulitis is most often caused by the organism Hemophilus influenzae. Other organisms such as Staphlococcus aureus, streptococcus pneumoniae and beta hemolytic streptococci also may cause this condition.

Infants and children up through age six to seven-years-old seem to be particularly susceptible to infection with Hemophilus influenzae and are most at risk. The incidence of severe Hemophilus H. influenza caused disease has decreased steadily since the introduction of HiB vaccine (Hemophilus influenzae B).Risk factors are related to the causes of the infection. The actual incidence is not reported, but it is a rare infection.

Prevention:
Immunization with HiB vaccine according to recommended schedules generally will prevent most Hemophilus infection in children. Young children in the same household who have been exposed may receive the prophylactic antibiotic Rifampin although this generally is reserved for siblings exposed to other Hemophilus diseases such as meningitis and septicemia.

Proper evaluation and early treatment of sinus, dental, or other infections may prevent the spread of infection to the eye(s).

Symptoms:

• fever, generally 102 degrees F or greater.
• painful swelling of upper and lower lids (upper is usually greater).
• eyelid appears shiny, taut and is reddish or violaceous (purplish) in color.
• Infant or child appears acutely ill or toxic
• eye pain (eye burning, itching and discharge)
• decreased vision (because the lid is swollen over the eye)
• eyes, bulging (forward displacement of the eye)
• swelling of the eyelids (see facial swelling)
• general malaise
• restricted eye movements

Signs and Tests:
Tests commonly include:

• a CBC
• blood culture and sensitivity
• a spinal tap in extremely sick children

• an X-ray of the sinuses and orbit
• a CT scan or MRI of the sinuses and orbit
• a culture of eye drainage
• a culture of nose drainage
• a throat culture
• a blood culture

Treatment:
Hospitalization is always required. Treatment consists of IV fluids with antibiotics. Surgical drainage of an abscess may be necessary.

Prognosis: With early recognition and treatment the patient can be expected to recover fully.

Complications:

• cavernous venous sinus thrombosis
• hearing loss
• septicemia
• meningitis
• optic nerve damage and loss of vision

This condition is considered a major ophthalmologic emergency that requires immediate treatment. Call your physician if your child exhibits any swelling of the eyelid, especially if it is associated with fever.