Cellulitis of the Eye in Children

What are orbital cellulitis and pre-septal cellulitis?

These conditions refer to an inflammation and infection of the eyelid skin and/or the eye socket (orbit). They are serious infections that involve the eye and the structures around the eye. Pre-septal cellulitis involves the area from the skin of the eyelid to the bony area that encloses the eye. Orbital cellulitis is an infection that involves the eye and the eye structures within the bony cavity of the face. Both of these conditions are serious and require immediate medical attention by your child's doctor.

What causes pre-septal/orbital cellulitis?

The most common cause of these types of cellulitis is from an infection with bacteria. The following are the bacteria that are usually involved:

• Staphylococcus aureus

• Streptococcus pyogenes

• Haemophilus influenzae

The bacteria gets into the eye and the surrounding cavity many different ways. The two most common ways the infection gets into the eye include the following:

• Trauma. Direct trauma to the eye can lead to infection from the bacteria.

• Spread from other areas. Most commonly, the infection begins in the sinuses. The sinuses are cavities, or air-filled pockets, that are near the nasal passage.

What are the symptoms of pre-septal cellulitis?

The following are the most common symptoms of pre-septal cellulitis. However, each child may experience symptoms differently. Symptoms appear abruptly and may include:

• Swelling of the upper and lower eyelid

• Redness of the upper and lower eyelid

• Warmth of skin

• Pain

• Fever

• General discomfort of the eye

The eyeball is often not affected and appears normal.

What are the symptoms of orbital cellulitis?

The following are the most common symptoms of orbital cellulitis. However, each child may experience symptoms differently. Symptoms appear slowly and may include:

• Swelling of the upper and lower eyelid

• Orbit becomes swollen and bulges

• Eye may appear red

• Decrease in the child's ability to move the eyeball

• Decrease in vision

• Fever

• General discomfort

The symptoms of pre-septal/orbital cellulitis may resemble other eye conditions or medical problems. Always consult your child's doctor for a diagnosis.

How are pre-septal/orbital cellulitis diagnosed?

Diagnosis is usually based on a complete medical history and physical examination of your child. In addition, your child's doctor may order the following tests to help confirm the diagnosis:

• Blood tests

• X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

• Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays. The extent of the infection is detected by performing a CT scan.

• Magnetic resonance imaging (MRI). A diagnostic imaging procedure, without the use of X-ray, to evaluate the extent of infection. 

Treatment of pre-septal cellulitis

Specific treatment for pre-septal cellulitis will be determined by your child's doctor based on:

• Your child's age, overall health, and medical history

• The extent of the condition

• Your child's tolerance for specific medications, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

Treatment will usually include oral antibiotics. Close follow up with your child's doctor is necessary for constant monitoring.

Treatment of orbital cellulitis

Specific treatment for orbital cellulitis will be determined by your child's doctor based on:

• Your child's age, overall health, and medical history

• The extent of the condition

• Your child's tolerance for specific medications, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

Orbital cellulitis is a serious condition and must be treated promptly. Treatment may include:

• Consultation with an ophthalmologist (eye care specialist)

• Hospitalization. Your child may be admitted to the hospital for antibiotics through an intravenous (IV) catheter. Hospitalization also allows for close evaluation of your child and the condition.

• Surgery. Surgical drainage of the sinuses or any abscesses of the eye is sometimes needed.

What are possible complications from pre-septal/orbital cellulitis?

The risk of complications may be reduced with prompt and accurate treatment of the problem. The following are some of the more common complications that may occur:

• Meningitis (an infection of the lining outside of the brain and the spinal cord)

• Loss of vision

• Brain abscess (with the possibility of permanent neurological deficits)